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ul <br /> SAN JOAQUIN COC! Y <br /> W." 'X ENVIRONMENTAL HEALTH DEPARTMENT <br /> --_- 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax: (209) 464-0138 Web:w w.s' ov.org/ehd <br /> � Ip <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: I�x n c t,�T ' � Date: 23�� <br /> Address: 2� 2 J c r 1 ��u. 1 G J City: C k o oic tur 1 Zip Code: �� <br /> Owner/Operator. pure p'Jm� %A(A 1"• Telephone: ffq _ 4-5d� <br /> Program Element: I � �C./ Program Record: Fj tlF �� n e ion Type: f2r. ..1 n eJ` <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: �^" <br /> OE-SEFVATIONS AND CORRECTIVE ACTIONS <br /> inod M n 1.S cd wundl C4 <br /> cars n cR- cm ► - "aintain a - <br /> cu rren i- Fera trh ,P,rrc� not- Crn Mcllflialn G <br /> C Ur s� tl hm�s- <br /> ItemlLocation �TemperatureL _ -- Item/Location _ kTemperature <br /> ..... <br /> Food Safety Certification — ` Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: U of �Chlorine: ppm Heat: eF <br /> Exp.Date: arewashing Sink: of at.Am m.: ppm Other: of <br /> Received By/Title: J <br /> EH Specialist: Phone: <br /> r) <br /> w / <br /> Time in: 12:007J Time Out: ' 2 1 (� Page f <br /> EHD 16-24 (2nd pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />