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SAN JOAQUIN COMO <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.orq/ehd <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />Name of Facility: <br />IA /Ail (--- it 1 eL,,,,,,,P- Date: i 2 _ 0 2p _ 1 g RCS el i-i vi , <br />Address: 7s- ,-;-0 A 1 Z1' t c Irv\vu City: 5 h.? (.., khyvv Zip Code: 1 5-2o c Telephone:20 .20 42, z vs_y Owner/Operator: etwi.y.".7,..:;1 <br />.0.- <br />Program Element: Program Record: Pe os-os-26 2- <br />Inspection Type: , r h o , <br />SB180 Posted Yes NO Permit Posted Yes No Re-Inspection on or After: <br />OBSERVATIONS AND CORRECT VE ACTIONS <br />7i-u'( ti4 ''. k 4A,44 /4 " 0 cf:iW c <br />Ae, 1- 'W2Z" /4,./....4 A,4,......_ A7J/Rizei,-/ eke <br />/IS 12° Slyz./2 61/,/, frd1t.1 <br />Aio IlJp 0:6'al-11-?;14•4 <br />' 0 leit'll 42 I 5 C. &4e. 44.1,-1-4.----7. q>°67 /4 67)4-"are"------ <br />/ 5 /fA-'e t <br />r.. <br />Item/Location Temperature Item I 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: o F Quat. Amm.: ppm Other: °F <br />Received By / Title. 4i ft.re-- ---' <br />EH Specialist: <br />" <br />Phone: • , <br />'t4eiette..- 04-16i L'I/t,ti Y5-3 ? 4 '). <br />Time in: <br />qt1 41 c MY <br />Time Out: ,9 / a, /2/-1 Page of <br />EHD 16-24 (2nd pg) 4/3/13 <br /> FOOD PR