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SAN JOAQUIN COUNT <br /> a` ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • c .• ;P• Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.sigov.org/ehd <br /> A�iFOR�' <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: 7 ., v Date: f7 1 <br /> IT E <br /> Address: 'R r City: � � �( Zip Code: <br /> Owner/Operator: rY�L,f? M�,�'�n>(�� Telephone: X421 <br /> Program Element: r aC v 1— Program Record: l L.�: 4 C--0 Inspection Type: (C ICA(11+ <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> �.JP�"1 <br /> `(*bc)45 CO- -%0c ':S hc"z <br /> L h ;LDC, hl S 121u� n hi <br /> Vr� aC l,(G 1"hL� fi u- <br /> Ur 1 �1 G VkaV-W-f <br /> V0 + S.P on ^JN - (40 e cf )i1 '(Je- The- <br /> iz i vo-�e \--)c , <br /> Item/Location Temperature Item/Location Temperature <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: of Chlorine: ppm Heat: of <br /> Exp.Date: Warewashing Sink: of Quat.Amm.: ppm Other: of <br /> Received By/Title: �^L <br /> r <br /> EH Specialist: V� Phone: n /l — 1G!_ <br /> Time in: n _ Time Out: e?: V Page j of <br /> I <br /> 16 EHD 16-24 (2^d pg) 4/3/13 FOOD PROGRAM OR CONTINUATION <br />