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SAN JOAQUIN COUN". <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:. --Z -) 1,1 _.c 1(7..-7_47(--ce.,Ci -4742-C (a 3 / 7 P Date: //'//? <br />Address: •_.7.9...z_ j--1, E." 7.7.1)/_4,Lde, LW.: City:._5/7.1„._ AA) <br /> '7 <br />Zip Code: <br />Owner/Operator: <br />A/ 27/1. I <br />/ 4/4 <br />(-./i !' PA l.-t 0 ..-79 5, Telephone: <br />Program Element: <br />7 <br />•P r o g r a m Record: 7liz. 0 ..5-3 _7 ‘,:,, ..., ..... 5- Inspection Type: <br />P-01-4-Yer-'142. <br />0 <br />SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />aeZe-- /r4, chets-Y — e)7 • .=€..-t .742s-k- es ac/z. <br />ice__ ,74 re-- -1--e C4.2-4-994" ...))??--tyrzal,2— <br />reor-P--e_c_70---esme 0,1 c._PC31. <br />04- .'-"AZ) eg-kr-e ,-Ar- <br />`Peft-x-0.<5- /V0re--#2-11.4-.-•L- <br />Item/Location Temperature Item / 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: <br />EH Specialist: Phone: /i6,,p•-........._79--..5_,..2_ <br />-i'..r-Z5--- Time Out: Page of Time in: <br />/ /,-*(....5-- <br />EHD 16-24 (20 pg) 4/3/13 <br /> FOOD PROGRAM OIR CONTINUATION