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SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East HazeIton Avenue, Stockton, CA 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: wvvw.siqov.orgiehd <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />Name of Facility: 6.4,pe—s- ri ife-29'D /1 C #: iii /4 L / Z // tvcfilre'f4-0 Date: /1-16 _ /e/ <br />Address: 3 cro /k) Lt /ç 0.),ev City: 5/29C-Irt€Th <br />Zip Code: <br />g5-2.0.1— Owner/Operator: Telephone: <br />Program Element: Program Record: o Co 4/ 4 Inspection Type: PR -5- <br />SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br />OBSERVATIONS AND CORRECTIVE ACTIONS . <br />/-ts i(o F 5 ktilutAkA <br />3 c-vrwr 5 i vt, ic r. <br />goa540( (01(.11. ,e)„,‘ ut/A470,,A1/ /31 1--- <br />/ b coe-ai1 (F - <br />g 13 cAA- uip e ti-e-0%,(e 1/2 e- r2,a_9071-1, <br />e.I7. iZe-/ 5Mr a„v-Ai <br />Apa <br />-/-,,/ .s.._s e,t_<__ 20 20 te____/- Fi-i-Ge fee_ <br />r <br />Item/Location Temperature .1.Illak4t2221 Temperature <br />Food Safety Certification,: =. 1 Facility Hot Water Temperature Warewashing <br />Name: -- ) Hand Sink:o F Chlorine: ppm Heat: . <br />Exp. Date: <br />0 S-1 L.7 Z. ... Warew ng Sink: . Quat. Amm.: ppm Other: . <br />Received By / Title: <br />Pho <br />9& <br />: f EH Specialist: ne 2-cl ql 11 <br />Time in: / Time Out: <br /> <br />i 6 /Mr <br />Page of <br />EHD 16-24 (2,1 pg) 4/3/13 <br /> FOOD PROGRAM OIR CONTINUATION