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SAN JOAQUIN CO. TY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East HazeIton Avenue, Stockton, CA 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.slqov.orq/ehd <br /> <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />Name of Facility: 6 1 Tit roC r Date: l_fe-A/ I <br />Address: City: City: Zip Code: <br />Owner/Operator: <br />P—C't kit 1 11/4/1-1 rCIVO Telephone: <br />Program Element: Program Record: rflocr 0(004 Inspection Type: ei Ito —eq./ S ..{6bc <br />SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />1-N/ -01NcW 1 .5eAlir19 Fectcl‘l -17) .e0A ulY ,- ToodS <br />• <br />4 via optintAl2 tvcict and c4-11 <br />food5 <br />.Set1 w-klz)------p——r—e <br />Or 21zpcicx-04e <br />Itern/Location---- — Temperature kern / Location Temperature <br />Food Safety Certification Facility Hot Water Temperature 1 Warewashing <br />Name: - Hand Sink: ,F Chlorine: ppm rrieat: <br />iOther: ppm <br />' F <br />Exp. Date: Warewashing Sink: F Quat. Amm.: °F <br />Received By / Title: , 4( ' ii.,. 1_ <br /> <br />EH Specialist:I 1111 --wi . <br /> <br />lliP ir lb Phone: f-Aci _ _ b 4-4 Ca, <br />Time in: ‘ 7- 06 a Time Out: p. •• l' Page f o <br />FOOD PROGRAM OIR CONTINUATION EHD 16-24 (2^, pg) 4/3/13