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SAN JOAQUIN COUNTY <br /> r y ENVIRONMENTAL HEALTH DEPARTMENT <br /> '. 600 East Main Street, Stockton, CA 95202-3029 <br /> �q....,OR Telephone: (209) 468-3420 Fax: (209) 464-0138 Web:www.sjgov.org/ehd <br /> <<F <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: C j /L Date: <br /> Address: 4400C. 7- W7-Y 57- <br /> we— City: 1fy zip Code: <br /> (_ 5- <br /> Owner/Operator: crib� DF�/ /� Telephone: (63q— <br /> Program Element: 1 80 Program Record:fk4SZ`-107 3 Inspection Type: Sf 7� 01.5r T' <br /> SB180 Posted XYes 71 No Permit Posted Yes 0 No / J Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> S RF F a.i /v kA4;3.4,f_.S o Ao-t- T .4>ff r-) T 15 <br /> li 6PJ THS POWfT WO E. /p•rw5 t C S f f Igo_ 3, <br /> ft!}uGED r3` <br /> NIS S lAdu-b P/nuF I& <br /> Item/Location Temperature Item/Location Temperature it Item/Location Temperature <br /> Food Safety Certification Facillot water Temperature Warewashing <br /> Name: Hand Sink: of Chlorine: ppm 'Heat: of <br /> Exp.Date: Wara as Sink: of Quat.Amm.: ppm (Other: of <br /> Received By/Title: <br /> EH Specialist: Phone: <br /> Time in: I / Time Out: Page of <br /> EHD 16-24(2n1 pg) (1112/09 FOOD PROGRAM OIR CONTINUATION <br />