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SAN JOAQUIN COUNRY <br />'+ ENVIRONMENTAL HEALTH DEPARTMENT <br />- 600 East Main Street, Stockton, CA 95202-3029 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sigov.org/ehd <br />LI FOtta <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />Name of Facility: <br />Address: I L o,-) da— <br />AL) -e- <br />Date: 10-10-12 <br />City: 0 5+C-K.� n Zip Code: C <br />7 v <br />Owner/Operator: !J a 64 0. <br />1 C s <br />Telephone: 6 <br />Program Element: b 0 -x /0 ( Program <br />C <br />Record: 5 110O (.,5-7 <br />Inspection Type: ,h <br />SB180 Posted Li Yes _i No Permit Posted -i Yes i_: No <br />Re -Inspection on or After: <br />EHD 16-24 (21" pg) 1/18/12 FOOD PROGRAM OIR CONTINUATION <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />r:c- <br />rt 12G 4 - <br />Y <br />o r- <br />( A r -e rne <br />n <br />O-Fi <br />a <br />I h -at A k L <br />- rl. <br />r c w <br />la <br />r <br />r0 <br />r <br />j L <br />I <br />r <br />w-0 <br />� r <br />rro 1� <br />l�.e.. r rr1.o rn�_-fie ►'" L Lori -� � �' `-f "t-�' S <br />m -fie <br />ou+ w <br />U <br />�s <br />v 4-CtA UG <br />e <br />Item/Location <br />Temperature <br />Item / Location Temperature <br />Item /Location <br />Temperature <br />l ct <br />Ll I <br />w <br />u� <br />Food Safety Certification <br />Facility Hot Water Temperature <br />Warewashing <br />Name: <br />Hand Sink: / 3.3 of <br />Chlorine: ppm <br />Heat: of <br />Exp. Date: <br />Warewashing Sink: 1 Z o f <br />J <br />Ouat. Amm.: ppm <br />Other: o f <br />Received By/'1"itle: <br />EH Specialist: <br />n , <br />✓"✓t <br />Phone: 1 <br />I <br />Time in: i <br />Time Out: Page of <br />EHD 16-24 (21" pg) 1/18/12 FOOD PROGRAM OIR CONTINUATION <br />