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SAN JOAQUIN COUI I
<br />ENVIRONMENTAL HEALTH DEPARTMENT
<br />1868 East Hazelton Avenue, Stockton, CA 95205-6232
<br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sigov.orgiehd
<br />
<br />FOOD PROGRAM OFFICIAL INSPECTION REPORT
<br />Name of Facility: ik•\_ ji k , ck 0 ,A. ceA .4. --1 q "S" "; 5 - IA) 1 Date: i v it/ i c
<br />Address: 1 7 1 --) s R vl 0 v‘. City: _I_ 12r--
<br />-I-NA - Zip Code:
<br />Owner/Operator:,/.j Telephone s-..... (s7-03) c / cm at ;.ct. (-
<br />Program Element: /0.3 c Program Record: S (2- 73'o 2- Inspection Type. ....,
<br />SB180 Posted 17 Yes ri Permit Posted D Yes 0 I Re-Inspection on or After:
<br />OBSERVATIONS AND CORRECTIVE ACTIONS
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<br />'s/IN I G-c, (-0;)24.1 7 E 33 ?X --)zi Cr/
<br />LI C. -FIL:=R95119. 1 k C 3 5 Po i
<br />S +-oritt- liNc,i5 ja fia 1P33
<br />a.- 1 A c 14A I et ) sat 14 $4.-‘ iv ' kilt (0 Prilviett A•..0"."..- 0- ownzr , 1 r,
<br />*- bk. 120 ,t-il cid, e s 4 v. .2 - k ie-ie,
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<br />(19 6 .4,mirc
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<br />4( . A ( ei-tw $4. i 12.0 F
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<br />c9 .?ru-4 ((4-?-4cse c-voy„.. r _DtiV
<br />0 P rvii ,-,4 -Fowl &Lev, e.r ce-e- fifier,....te, t/d (7)4 il4 ( 0 U d 0 t y s .
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<br />14, ‘, ,;; , , ,-, g',1{• _
<br />Item/Location
<br />e-01{rafr.
<br />Temperature
<br />(( tt °F
<br />Item / Location ' Temperature
<br />Food Safety Certification Facility Hot Water Temperature
<br />- - Hand Sink: (, .F
<br />Warewashing
<br />Chlorine: ppm Heat: °F Name:
<br />Exp. Date: 44,i w 11 Warewashing Sink: . Quat. Amm.: ppm Other: °F
<br />Received By / Title: )\
<br />EH Specialist: tZ 1.-.Cix...i.v.,....c.....d.x.7e..,_ Phone: 4i,-
<br />Time in: I ( Time Out: f ( ..4- -5! Page of
<br />FOOD PROGRAM OIR CONTINUATION EHD 16-24 (2^, pg) 4/3/13
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