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SAN JOAQUIN COUNT <br /> N: X <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • c.., iP• Telephone:(209) 468-3420 Fax; (209)464-0138 Web:www.siaov.ora/ehd <br /> ALI FORA <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: � ! I <br /> Address: City: � Z v �T( Zip Code: <br /> Owner/Operator: LTelephone:T � 42 _ �,cic:� <br /> Program Element: rlJC v 1— Program Record: ,.c,—,o �" Inspection Type: (cm lun+ <br /> S6180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> C c; u•►nfi s�7,�S : �,.�� �r -;S S-�vr-� kc �ac-� �� v n a���-tvr <br /> '`�fiU�► CO lbe- crV4 `.S by <br /> -f h P ��JMe(, h uc:C 11 n h► <br /> V�efr i " G -T-uGK-(_?. T-N?_ u X1=5 r.2- 9Z4_= Co- je <br /> mit w PICA 1,kCrK fi <br /> v cl + S. cjn Ddu grdC f m �ce_ I'he- <br /> iz t vc42 hG-mec <br /> c c�fii�U.2 r izrC o f- r�Jc u � . <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.:11 ppm Other: 'F <br /> Received By/Title: � -, r �^,G <br /> EH Specialist: C :rte/ Phone: '7 /`A ! , f� <br /> Time in: n Time Out: �age <br /> . <br /> EHD 16-24 (2n'pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />