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SAN JOAQUIN COUN, <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.orcilehd <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />Name of Facility: Name of Date: <br />City: Zip Code: ddress: 35-s-70/v4 <br />ck 4-Y1 _SIZ) <br />Owner/Operator: Telephone: <br />Program Element: Program Record: Type: R Inspection v co q 9- g4 <br />S B180 Posted Yes Permit Posted Yes <br />NP0 <br />Re-Inspection on or After: <br />OBSERVATIONS AND AND CORRECTIVE ACTIONS <br />51 laic_ i 3 i--='• <br />E' - <br />.---g-4' ' Kt.cc.kel / / 4 L k".--es.._ C 00 pp Ye-1%. ) I-42 -1_0{1- c CaAirl-e p <br />evo-6--7 4/ <br />P 3 ,-,,--4.e(Arkte/rs- , ce kap/71-,. c Lieli . D i 44 Z' fa, <br />AA"- 174,0 e--t...—e . fYi I11-tAii'L-5 / , 1 <br />4 , pg./ fool cAA 14-4- 1.1sici 41,-- (WI-et aLOLt_ r -(9 S <br />+1,0C1 eteaftiredi rAise ('c AID1- e-dak7.44k._ , fire Vt`ti (II <br />d day f . <br />okal i'(-&/ S- ,C <br />Item/Location Temperature Item / Location Temperature <br />Food Safety Certification Facility Hot Water Temperature Warewashing <br />Name: Hand Sink: .F Chlorine: PPm Heat: °F <br />Exp. Date: Warewashing Sink: .F Quat. Amm.: ppm Other: °F <br />Received By / Title: r-- cit_om 61 p <br />° /lc_ 26 , Z 2 4 I q- <br />Phone: <br />/5- <br />3 <br />EH Specialist: y,„..71 I <br />4/ 3 6il'i( <br />:44' Time in: . 1 v Time Out: Page of <br />EHD 16-24 (2,,d pg) 413113 FOOD PROGRAM OIR CONTINUATION