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01�.gwIV...0 SAN JOAQUIN COUNI T <br /> z+ ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> cq.• iP Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.sigov.org/ehd <br /> ��FORN <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: 11P <br /> (%1�A1Date: _.Z _ <br /> 12 <br /> Address: V r I P k) City: Zip Code: C?S C <br /> S /Gh 1C <br /> Owner/Operator: C G� r I o` Telephone: <br /> rc <br /> Program Element: f12 Program Record: ! S 6 7�2 Inspection Type: <br /> S81 80 Posted i_i Yes _1 No Permit Posted C Yes -1 No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> O0C r. CCLL12,4i r^ ;c, 4/ <br /> V, vio4;o <br /> L Pr.Clul e — 1 u <br /> PVI - <br /> m violoI ; <br /> Item/Location Temperature Item/Location Temperature Item/Location Temperature <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: 'F Chlorine: ppm Heat: F <br /> Exp.Date: Warewashinq$Lmk-___ 'F Ouat.Amm.: ppm Other: 'F <br /> Received By/Title: <br /> EH Specialist: one: <br /> Time in: Time Out: !l Page of <br /> EHD 16-24 (2nd pg) 1/18/12 FOOD PROGRAM OIR CONTINUATION <br />