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oPq�!tf, I SAN .JOAQUIN COUN . . <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />.. p Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sioov.org/ehd <br />dUkbti'� <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />I <br />Name of Facility: -1'Kf <br />' S Ii u - 55 <br />22 \/ <br />Date: tQl <br />IT <br />� <br />Address: 'v�Qr <br />K. <br />G.!(- City. <br />GA- <br />pct ca.,(Ij.e <br />Zip Code: <br />eb <br />Owner/Operator: � <br />-Wrart <br />Telephone: -t —+ 3q� _VGq 1 Z <br />TU � <br />Program Element: t Program Record: Q -r tF-i 0C'] a U <br />1 i <br />Inspection Type: kkt-h <br />P./� <br />B180 Posted es ❑ Remit Posted /,"Yes 0 1 <br />Re -Inspection on or After: <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />U •veq\ vemOur <br />cebntCA.\tc" <br />N <br />("JtDCA;S <br />U <br />GAP - �ml <br />1 w <br />-1`01 <br />isS� P�f � i <br />201 <br />ItemlLocation <br />Temperature <br />Item I Location <br />Temperature <br />Food Safety Certification <br />Facility Hot Water Temperature <br />Warewashing <br />Name: <br />and Sink: 'F Chlorine: <br />Ppm <br />Heat: <br />"F <br />Exp. Date: <br />arewashing Sink: 'F uat. Amm.:ppm <br />Other: <br />"F <br />Received By I Title: <br />EH Specialist: <br />Phone: a 0 — A <br />_ 5 <br />Time in: <br />0 2 5 <br />Time Out: I () i & 0 <br />Page lof <br />EHD 1624 (2- pg) 413113 FOOD PROGRAM OIR CONTINUATION <br />