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,oP4 .�oo SAN JOAQUIN COI Y <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> . cq. ;P• Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.sagov.org/ehd <br /> 5FORA <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: �� C I. �� Date: 1.21/_ - <br /> Address: Lr a c„6.t G Av-e- City: c+O CK-�-o n Zip Code: 95 <br /> Owner/Operator: c Telephone: <br /> (� X115-321000 <br /> Program Element: (y Program Record: ( -0 $S 1 Inspection Type: l�S <br /> SB180 Posted ! Yes No Permit Posted a Yes ❑ No Re-Inspection on or After: <br /> ®: 'i BSERVATIONS AND CORRECTIVE ACTT© <br /> l 1'0 CPQ-r 4P1=1 &01t4_'7Lkr-� 9- �_-3 <br /> r� <br /> L <br /> /'A' I_j/,v J.-A 4,�,x t_vj-,--e -7 n e7 :L"c of :5-- ­C'K <br /> Item/Location 1 Temperature Item/Location Temperature <br /> - - --.— _........... _ <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/TRI <br /> EH Specialist: /v�_ / L� Phone: <br /> Time in: ` (� 7 Time Out: Paget of <br /> EHD 16-24 (2nd pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />