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SAN JOAQUIN COUNT <br /> gyp. C <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 /> �iFORN <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: d-i e r ' Date: <br /> Address: L City: 0,fe Al Zip Code: <br /> Owner/Operator: / y , Telephone: <br /> Program Element: Program Record: / GL Inspection Type: <br /> 14 <br /> S131 80 Posted - Yes ❑ No Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> ✓LC- LZ Y G' �-ni Gtcv. 12-1 L'L <br /> ZI luk /V U vul W,G ti d <br /> -ZWI^ diP <br /> e . p W. ave(u -c(A vim- <br /> CG vl I/L( •f' �- �t� r� d t, bvtJ GC c (. <br /> at v wf -�t /0- Il <br /> Item/Location Temperature /Location Temperature Item/Location Temperature <br /> r <br /> luo mon-4- r Ike <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: of Chlorine: ppm Heat: of <br /> Exp.Date: Warewashing Sink: eF Quat.Amm.: ppm Other: of <br /> Received By/ C <br /> EH Specialist: w� Phone- <br /> Time in: Time Out: Pagezof� <br /> EHD 16-24 (2ntl pg) 1/18/12 FOOD PROGRAM OIR CONTINUATION <br />