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PgU�N SAN aJOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> _ 600 East Main Street, Stockton, CA 95202-3029 <br /> Telephone: (209) 468-3420 Fax: (209) 464-0138 Web:www.s'gov.org/ehd <br /> 4:i ii <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facilit U 4, Fo O(15 Date: Z, .2' _U <br /> Address: <br /> Zip Code: <br /> 0 ) <br /> Owner/Operator: <br /> Telephone: J <br /> Program Element: Program Record: Inspection Type: '/f1 <br /> 6180 Posted ❑Yes No Permit Posted Yes 7 No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> 13 M—Ka - a r e - •1tile5 L_X F! .,�1. y _ , v1 4 ci r C l ca n-- <br /> e_- <br /> re 51roorvi <br /> d W Q 1 oA d i S A SO n " C. k 5.4 <br /> C r\ i d-,a P1 <br /> 0 Den <br /> SII D l" ble C <br /> e.'4 Sh u 9 /i d1 A h e I a doY <br /> ra '1 0 r. Co rrec4o do St <br /> itj,7 .0 Lt n ro ),raih¢ rrix 4vd'*' <br /> S I Serve bren d cvA Icr Ird CK <br /> Imin �-a In 5ot .0e e r Ca !e <br /> Item/Location Temperature Item/Location Temperature <br /> Food Safety Certification l Facility Not Water Temperature Warewashing <br /> Name: I'Hand Sink: of Chlorine: ppm Heat of <br /> Exp. Date: 1 arewashing Sink: of iQuat.Amm.: ppm Other: of <br /> Received By/Title: Cu';4- C ���-=&Z <br /> EH Specialist: Phone: / <br /> Time in: Time Out: �j✓ Page of <br /> EHD 16-23(2n°pg) 07129/09 FOOD PROGRAM OR CONTINUATION <br />