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SAN JOAQUIN COUN1 <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East HazeIton Avenue, Stockton, CA 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sigov.orq/ehd <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />Name of Facility: -71) 6 eh,i , ...tt 3/ (it 4,1 Date: ,2_ l b _ ;6 <br />Address: I 7 1 I s 0,;6,-, City: S-nen Zip Code: 9 s.506 <br />Owner/Operator: <br />C I 6 r, , 61 i ; r 4 if I <br />Telephone: 9 3 if ,73 2 i <br />Program Element: 16 3 -2) <br />Program Record: <br />,c --) 3 70 Inspection Type: R 0 1A 4 I ike <br />SB180 Posted E Yes 0 Rermit Posted E Yes 0 NI 1 Re-Inspection on or After: <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />, LI • 34: , L:C ) <br />V. A 14 7 q 9 <br />I Pre/ V ; G h )6, , no 4 , S 4 5 4 rp i n tA)ee K r\ <br />5) pr,i; el 2 -V o 0 41 rr o n c r C rr ), f ; ec, le , I rYle ,,--i I 11 v <br />3 p r vv.' d c Z ; p c c ii or' bo .1 ki S (if c r k e h ; (19 1 4 <br />ni C fl 1 h• <br />0,k - <br />e rm,. 4. c 24S 0 n 1 e ., ,.• :., A 4,1 . .1 • 1, <br />/ <br />Item/Location , „ , Temperature ..___ _ Item I Location Temperature , _ <br />r , i s 1 <br />Food Safety Certification <br />Name: <br />Facility Hot Water Temperature , --, Warewashiag <br />Heat: . 4-land Sink: WC/ 4 <br />.F Chlorine: ppm <br />Exp. Date: Warewashing Sink: 1244 0 Quat. Amm.: ppm Other: . <br />Received By / Title: --t- id #7, :I kit& <br />EH Specialist: yew AG, Phone: A . i .., ... 44r •34, <br />Time in: sx':o I- - Time Out: a . <br />• 2ei <br />Page of, <br /> i 0 <br />EHID 16-24 (2nd pg) 413/13 FOOD PROGRAM OIR CONTINUATION