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SAN JOAQUIN COUN <br /> ape .COG <br /> .2� ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> . �q.... 'N`p• Telephone:(209) 468-3420 Fax:(209)464-0138 Web:www.slgov.org/ehd <br /> �/FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: r-0 CQ_ Date: L-(� <br /> Address: ' 2 A ., City: 1j Zip Code: <br /> Owner/Operator: 1 ``'Ivy`r �.L Tl fo Telephon /,y Io /�(_ I --) <br /> Program Element: Program Record: 5 .� Inspection Type"I� „L '� <br /> S8180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: ��-v "fL <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> 0 2071- 00 r _2") <br /> uc, e i i -i a La <br /> Le) 6 7f3P)T 41345 45 a143 - <br /> i ` r e Ls mo <br /> a o <br /> ? e VUs YnA,n.� rY►v r►, <br /> -S el ' c o 1 t,►-ze h 'rn u m <br /> OLD r ry%� &71 <.� A-*- kLOLU al w <br /> rs - <br /> L bSU t w� + <br /> Item/Location Temperature Item!Location Temperature <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: `F Chlorine: ppm Heat: 'F <br /> Exp.Date: Warewashing Sink: 'F Quat.Amm.: ppm Other: 'F <br /> Received By/Title: > (, C2 `l <br /> EH Specialist: Cjl,,t4 Phone: L �n <br /> Time in: Time Out: 7 / Page of <br /> 1•0 <br /> EHD 16-24 (2nd pg) 4/3/13 FOOD PROGRAM OR CONTINUATION <br />