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SAN JOAQUIN COUNT' <br /> : Z ENVIRONMENTAL HEALTH DEFmRTMENT <br /> 4: <br /> - - 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> �4•.,,- .a�P Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.sigov.or /q ehd <br /> L/FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: V�; U ('(-( s '-U r-c, h.L <br /> Date: <br /> Address: �--6(0c) �Vn j- -1 N J <br /> City: c�a,..,•,�r un Zip Code:q 11;-701K- <br /> Owner/Operator: <br /> 0� <br /> Owner/Operator: R OSG a C s+ 11 Q ,v Telephone: too - !_14 O� <br /> Program Element: (OU;�,> Program Record: S1�UU"l- lZ &,7- Inspection Type: cqn,�\A11ZA1 1-bn <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> ,F.,.,= .. ..... :.., a. .... C}BSERVATIC?NS AN©C;ORRECTtV�:�4CT1©NS .' <br /> Re :4*t &moi <br /> -� G �:oo `S C �i i G <br /> 0 VOCd k►-Md\-Qr c 1\ ges <br /> ny- <br /> _ -;5 - y � t �c Ufi Co mks <br /> -t'+ei - <br /> ko. sC�v <br /> ----------------- <br /> Item/Location TemperatureItem i Location Temperature <br /> ?� vrl�-5f tl t <br /> Food Safety Certification Facility Hot Wafer Temperature Warewashing <br /> Name: Hand Sink: �U F Chlorine: ppm !Heat: -F <br /> Exp.Date: Warewashing Sink: + t of lQuat. Amm.: ppm Other: of <br /> Received By/Title: ' <br /> EH Specialist: Phone: /4 <br /> Time in: 61 -00 Time Out: ; (6- Page lof <br /> EHD 16-24 (2^^pg) 4/3113 FOOD PROGRAM OIR CONTINUATION <br />