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oPQul"= SAN JOAQUIN COU. l <br /> ).•'cam •.OG <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax: (209)464-0138 Web:www.sigov.org/ehd <br /> <<FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: i ._ z V X d 0-"_-� Date: <br /> Address: nd R_ -CLO- _ 1 City: tp L� Zip Code: �G�Q <br /> Owner/Operator: G� �,v �,f� 1!J Telephone:AI A <br /> Program Element: i Program Record: U5^�tq�q_ Inspection Type: -film <br /> SB180 Posted es No Permit Posted Yes No ✓ Re-Inspection on or After: �--- <br /> OBSERVATIONS AN[.CORRECTIVE ACTIONS <br /> Tilt, r WA C1ovr I,S rale i rYA 99Ck r+ - - x d <br /> d of Tb5T'0d-�6j9S isStDFAej Cn -th0 c Uvl - e Co Yr <br /> aF k- 'fhb CA PL CAArd <br /> Ger eA4 Keu YAh ,2rm-i f no{- cn SW 1AUi rn- (n a Copw oR <br /> S- <br /> -V- ocr e2_0 r4- <br /> - - - - - - - .... - - -- - <br /> C'r <br /> Item/Location TTemperature Item l Location Temperature <br /> Food Safety Certification Facility Hoi Water Temperature Warewashing <br /> Name: and Sink: Chl <br /> of orine: ppm Heat: of <br /> Exp.Date: arewashing Sink: 'F Quat.Amm.: ppm Other: `F <br /> Received By/Title: <br /> EH Specialist: Phone: 62 <br /> 0-bo <br /> Time in: 1 (� Time Out: ; O : 2� Page Pf <br /> EHD 16-24 (2n°pg) 4/3'13 FOOD PROGRAM OIR CONTINUATION <br />