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SAN JOAQUIN COU► <br /> y� ENVIRONMENTAL HEALTH DEPARTMENT <br /> J. 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax: (209) 464-0138 Web:www.si4ov.orq/ehd <br /> ��FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Vi <br /> I �' S j L ate: j ,? <br /> Address: City: 1p o <br /> Owner/Operator: MAN Itti� Telephone: Z 1- — .Z <br /> Program (Element: Program Record: - Inspection Type: <br /> V§-180—Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> r <br /> 1AJ <br /> l <br /> G )d2 <br /> t� 0 i1 <br /> a> J <br /> 0 ;ssPIP 0-11 - •6'�l. <br /> / a C+Okl <br /> ^_� f / rte' • ��" <br /> Itetr Location mperature _ _Item 1 Location Temperature <br /> ... -- .............--- - _..__... <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: "t' °F (Chlorine: ppm Heat: 'F <br /> �u <br /> Exp.Dat Warewashing Sink: 'F Ouat.Amm.: ppm Other: 'F <br /> Received By/Title: <br /> EH Specialist: Phone: <br /> Time in: - Time Out: Page of <br /> c <br /> EHD 16-24 (2W pg) 4/3113 0001)PROGRAMIR CONTINUATION <br /> �.�iYL et+ <br />