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SAN JOAQUIN COUN1 _ <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> . �q.. a`P• Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.sigoy.org/ehd <br /> ��FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: 44 a 0i'ClarJ11A, 11,PC46tI W,( K Date: 6 - 2 —/ 2- <br /> Address: <br /> / ZAddress: Vt C cS City: n /J�� ` Zip Code5 <br /> Owner/Op rator: r , ` Telephone: 7 2 <br /> Program Element: / 8 !` ogram Record: Sa �2 S 3 706 Inspection Type: _I <br /> SBI 80 Posted Li Yes ❑ No Permit Posted ❑Yes ❑No Re-Inspection on or After: w�► �� <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> Uj- Gr /lie, rvi S <br /> l O o <br /> r rq /3 -1 Fa,-M5 - <br /> 0 <br /> - L - � . <br /> 6 2 0 s O-V) — <br /> I <br /> C) V a 0A r <br /> s- Yl <br /> �o <br /> M E, <br /> f-e I L11 <br /> I-e (Ord - <br /> N-0s C�o O - <br /> r 1C CVLW <br /> Item/Location Temperature 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: 'F Quat.Amm.: ppm Other- o f <br /> Received By/Title: S V <br /> EH Specialist: j! Phone: <br /> Time in: Time Out: Page of <br /> EHD 16-24 (2^d pg) 1/18/12 FOOD PROGRAM OIR CONTINUATION <br />