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C <br />op,AHlfyc SAN JOAQUIN COUNTY <br />t' ��•`pG <br />a' <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />4......• '`p.. Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sigov.org/ehd <br />�1rtda� <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />Name of Facility: ✓o-koLLS <br />StirDate: <br />l <br />2 <br />Address: ./1 rU /. /� <br />VV <br />C(ty: <br />I Zip Code: <br />ZZ <br />Owner/Operator: <br />Telephone: <br />Program Element: 16 /t _ 1 Program Record: �+ 2 <br />1 7 <br />Inspection Type: <br />mo- <br />SB180 Posted Yes No Permit Posted Yes No <br />Re -Inspection on or After: I/W <br />T023 <br />3 <br />_ <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />41 WC-lx4rg <br />'Z� <br />S t <br />LLlL-' v1 <br />- L <br />r-71 <br />tG <br />7,v S ; <br />i S <br />t <br />flG- <br />© N1 a <br />1 <br />J J <br />/FL <br />o <br />rP ' <br />////� <br />'L 6s�A <br />LL <br />.Sr r <br />l 'O O a <br />r' <br />K WW O <br />Sao <br />rti <br />ItemlLocation ` <br />-elnperature <br />Item/Location <br />Temperature <br />Food Safety Certification <br />Facility Hot Water Temperature Warewash(ng <br />Name: <br />Hand Sink: <br />"F Chlorine: ppmeat: <br />'F <br />Exp. Date: <br />Warewashing Sink: <br />'F Ouat. Amm.: ppm <br />ther: <br />of <br />Received By/ Title: rT <br />EH Specialist: ^ O <br />Phone: <br />ime In: - ' ' q <br />Time Out: I(c /J //� <br />Page of <br />EHD 16-24 (2b Pg) 4/3113 FOOD PROGRAM OIR CONTINUATION <br />