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SAN JOAQUIN COUNIMI <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East HazeIton Avenue, Stockton, CA 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sigov.orci/ehd <br />L-1 t3 <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />Name of Facility:b. \ _. G m <br />• <br /> Date: t \ 2_“— I 9 Q•,...„‘„ .. ,., <br />- Address: !---i 1 ---7 cs .) <br />k' City: Zip Code: <br />‘.. <br />\ <br />Owner/Operator: el....\. \ c\c ,c <br /> <br />) c3,1 -_-%-- ---) ,.c. -- "T ‘ )( .Q/. .- \,, '`..if e Telephone: ....s <br />Program Element: Program Record: Inspection Type: <br />SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />(-1"r41"4-9 <br />..2 b b te 2 Li•( g/c--,2-Q P (1J-Q -4-- k3,1 <br />\_,) N) 0 01-ci b <br />CX_ ,. • Alma <br />-f-.......‹..k.,_ c k <br />, s pc"A <br />c <br />)....Q.,.....,N., <br />Item/Location Temperature Item / Location Temperature <br />F- <br />,z_1--- . <br />Food Safety Safety Certification Facility Hot Water Temperature Warewashing <br />Name:6 ‘ a( e5 thsz •ks Hand Sink: o F Chlorine: ppm Heat: . <br />Exp. Date: ut _ 22 _ 2 Warewashing Sink: °F Quat. Amm.: ppm Other: . <br />Received By / Title: —4 WOW <br />EH Specialist:(*.. _ks.se,y\..14..... ,..._ \f---Ar-V,A, <br />Phone: \_,{ <br />Time in: i k 0.,- c.,yy....\ Time Out: t I . <br />1--_-_—_/ , <br />I —1- C--(VM <br />Page. of <br />EHD 16-24 (2nd pg) 4/3/13 <br /> FOOD PROGRAM OIR CONTINUATION