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SAN JOAQUIN COUic <br /> a ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • q.. c ;o Telephone: (209) 468-3420 Fax:(209) 464-0138 Web:www.slgov.org/ehd <br /> L/Fo'na <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: n �� r Date: <br /> Address: '-(('0 <br /> o C_ .C_ AV-e- City: C�GKt�� Zip Code: 5 7 <br /> Owner/Operator: I T►'CA h v-e rs o J Telephone: <br /> Program Element: 12 Program Record: P R 05 001 ,3c) Inspection Type: <br /> 8180 Posted es No Permit Posted s n No Re-Inspection on or After: �� xS <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> .t v--e- t2 v/ r--p- v r ngd 0 t4- Lq ce <br /> rn GH df_ .o r L4'r)-74-;ndl <br /> 0 n S Y�2 Yto�' �re c>r • � cc.1r� ccl t�j <br /> ►� r d It u 4-e. o r C Az , <br /> rr-fi'Lc�-fitlri S � ✓-�s^fr rr�s a r•.e r ' <br /> /' C2r cst� i r-c of cj � <br /> b da <br /> Item/Location Temperature Item/Location Temperature <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> --... -- -- —.._._._,_ - —----- -- -— ------ -- ---....—..........._._.......__.._......-- -L'eat <br /> --- <br /> Name: Hand Sink: nF Chlorine: ppm of <br /> Exp.Date: Warewashing Sink: of Ouat.Amm.: ppm : of <br /> Received By/Titl <br /> EH Specialist: Phone: 91?j <br /> Time in: t�5 `vv'v Time Out: —7-) bs Page of <br /> EHD 16-24 (2nd pg) 4/3/13 v� FOOD PROGRAM OIR CONTINUATION <br />