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SAN JOAQUIN COU <br /> Sltf <br /> ).• •.OG <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax:(209)464-0138 Web:www.s*gov.org/ehd <br /> <<FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Y_n 't, q/ q Date: q-'2/— <br /> Address: D y�. , )� City: Zip Code: <br /> Owner/Operator: "Ori G ve rr , Telephone: L'p _ �3 3 <br /> Program Element. / 3 Program Record: PRD 5 3 0"4;0 Inspection Type: 0u � (o <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> vp ra rs rr�,.ss;.7 - % -Pro v-; <br /> - <br /> a h m-e- 5-0 - h 44LL <br /> of h d �' <br /> ee�a4 1 -e. <br /> Y-W s a a s 4-r at CO r r� <br /> Y1 C <br /> Item/Location _ Temperature Item!Location Temperature <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: r 0r/CSS Hand Sink: j F !Chlorine: ppm PlHeat: F <br /> al) be _. <br /> Exp.Date: d J arewashing Sink: of Quat.Amm.: ppm !Other: of <br /> Received By/Title: <br /> EH Specialist: )_ Phone: JU 1 7 <br /> Time in: 1W�� 1i1l�t Time Out: /� Page of <br /> EHD 16-24 (2n1 pg) 4/3.13 FOOD PROGRAM OIR CONTINUATION <br />