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SAN JOAQUIN COUN'ft <br /> h 'j . ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax: (209)464-0138 Web:www.sigov.org/ehd <br /> �IFOR <br /> V A = <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: -- ` a(�' V <br /> 1 ce, Date: <br /> 2��� � <br /> Address: '' City: vjma_1_� Zip Code: Gts26(o <br /> Owner/Operator: O S Y Q Telephone: r_lq— z J t¢ <br /> Program Element: Prograam Record: P12, I it Inspection Type: HCl <br /> 6180 Posted ❑Yes ❑ Rermit Posted ` ❑✓Yes(,❑1 `T Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> L1(yJ1�S& 32-� fa-( <br /> TZ 00r Tt\� CAjZ0Ufd &VXe 0)l <br /> S (a " G- -fr "fhZ <br /> Cu q&t in;fi OM V(-eyvjcmS moi- �S not <br /> 01) C�e_ ' &ire a� rr limes <br /> J M - � 2U1 <br /> Item/Location Temperature Item/Location Temperature <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: of Chlorine: ppm Heat: of <br /> Exp.Date: Warewashing Sink: of Quat.Amm.: ppm Other: of <br /> Received By/Title: <br /> EH Specialist: / / Phone: aloci - 4 <br /> Time in: �r i�& Time Out: C 2 : 4`1�+W Page of <br /> EHD 16-24 (2^'pg) 4/3/13 v ! FOOD PROGRAM OIR CONTINUATION <br />