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am" SAN JOAQUIN COUR <br />y� ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />c •.• - ;p Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sigov.org/ehd <br />4��FORN <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />Name of Facility: i O C K u <br />L t L w <br />t� 5 a, <br />Date: ) .- 8, <br />Address: r A c 1 <br />6 1 V .4 <br />City: -T-t. V1 ` <br />Zip Code: S 3 7 <br />Owner/Operator: 1 <br />31��Khu�a:�,- <br />1 L C <br />la�l�.,, <br />Telephone: <br />Y3-04q.L <br />Program Element: I ! 2 0 Program Record: <br />V ` <br />Inspection Type: <br />SB180 Posted I Yes ❑ No Permit Posted I Yes I No <br />Re -Inspection on or After: <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />�f7tJ /� 15 <br />Cam-, r <br />5C <br />b oK t ns o <br />C or <br />GJ ee Il5 <br />. <br />ItemJLocation <br />Temperature <br />Item / Location <br />Temperature <br />Item / Location T <br />Temperature <br />Food Safety Certification <br />-Facility Hot Water Temperature <br />Warewashing <br />-- <br />Name: <br />Hand Sink: <br />�, r, of <br />Chlorine: <br />PPM <br />Heat: F <br />Exp. Date: <br />Sink: <br />pi aF <br />l <br />Ouat. Amm.: <br />ppm <br />Other: aF <br />Received By/ Title: `. <br />EH Specialist: <br />Phone:C <br />f �. y /U r <br />/ <br />Time in: I , /S• <br />Time Out: <br />Page of <br />EHD 16-24 (2^d pg) 4/9/12 FOOD PROGRAM OIR CONTINUATION <br />