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IND SAN JOAQUIN COMP <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.orq/ehd <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />Name of Facility: I O ilit h (A,r4L- 4ite I (jt . z -t - rir0 S" <br />Date: /1/ /I <br />ddress: 3 cs_o t. jva 4.v. City: <br />51/614-k4/1"` <br />Zip Code: _ <br />`--/ c -/cD • s — <br />Owner/Operator: Telephone: <br />Program Element: Program Record: p f) 0 cc S-Q, -2_._. Inspection Type: <br />B180 Posted Y No Permit Posted No Re-Inspection on or After: <br />'OBSERVATIONS AND CORRECTIVE ACTIONS <br />h ;,--s t, .06/,/m.t ,Mhtzliz-46.___ <br />(3 ‘ •/,,,,hi ,,,- .ff-S <br />,,-,t- 0 -dt /--j 0 A) 0 <br />i 5 S U e 213 2.0 it.e.__-t.-..—„ cryi_e, e fitia.4.7W ,,,,..e, <br />Item/Location Temperature Item / Location Temperature <br />Food Safety Certification Facility Hot Water Temperature Warewashing <br />Name: Hand Sink: 0F Chlorine: ppm Heat: 0 <br />Exp. Date: Warewashing Sink: 0 Quat. Amm.: ppm Other: 0 <br />_ <br />Received By / Title: 1 tWC <br />EH Specialist:_ Phone: 2- a 9 f c3 -X-6 IS <br />Time in: q 1 00 , Time Out: 41/c filf <br />Page o <br />EHD 16-24 (2n1 pg) 4/303 FOOD PROGRAM OIR CONTINUATION