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SAN JOAQUIN COU <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East HazeIton Avenue, Stockton, CA 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.siqov.orgiehd <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />_ Name of Facility: , 17-1,c y 1. It '..f ,j.4.4 p .01 k L . Date: <br />Address: tco e„ci iii„, Ciii mieg City: Zip Code: <br />Owner/Operator: a34/1)Yr 77(b.1 <br />Telephone: ee, oi <br />Program Element: .62:0,3 /(r,?; Program Record: ( C 3 1 /I I Inspection Typevac cf- <br />SB180 Posted 0 Yes 0 Hermit Posted 0 Yes 0 I Re-Inspection on or After: <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />, <br />I r 'ik c 6 5 , 4„./e i.L <br />W1411;(4 ( r - LP Oti-- riPF <br />J/VAP-t• 1/ jai <br />6 A D-A , yv \ • . <br />A4 iaGe4L<, -NI 0(P YleA.P(Anav.(_ OIA71- (Lev& • <br />44Lod pIt\airk a sm ( cioP4j . 0 A.cg-kk t, i i ,4 itin .1A," 0 <br />00.11 <br />' ,vi-e . 41 _ 3e#41,04 <br />-M•I'V't / C 0., i A '1()f,A i i v <br />Item/Location f Temperature ltefn / Location Temperature <br />Food Safety Certification <br />Hand Sink: <br />Facility Hot Water Temperature Warewashing <br />Name: / 6,,,:\ .F Chlorine: PPm Heat: °F <br />Exp. Date: Warewashing Sink: 1 ( t...1 .F Quat. Amm.: ppm Other: °F <br />Received By! Title: A iutia i <br />EH Specialist: <br />ti <br />Phone: Lk, g-aikci <br />)1,- Time in: 1 . 0 Time Out: Page of <br />EHD 16-24 (2nd pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION