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4µ1�•. SAN JOAQUIN COUNTY <br /> a ?� ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> c�`/FsR+p Telephone:(209) 468-3420 Fax:(209)464-0138 Web:www.siaov.org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: tA Date: pJ-3 <br /> Address: d An,r,i/v GfCity: Zip Code: <br /> Owner/Operator: vvv Telephone: <br /> Program Element: Program Record: ©�' / vInspection Type <br /> Set SO Posted Yes No Permit Posted Yes No i4e-Inspectlon on or After: f 12,01 3 <br /> OBSERVATIONS AND CORRECTIVE ACTION <br /> J ✓ —i v1 r <br /> Vkim At P\ <br /> vUf <br /> l <br /> tl? C— U <br /> 6 L J <br /> L 6� <br /> St wtaY al✓ VV BI �G 7 n - 7 <br /> 1 14 <br /> C # is L �� 1 <br /> Cj <br /> al✓ L-I W I ✓S <br /> w G l VV <br /> — wadi- $1 <br /> k�✓ vi Z b F I em✓ C fvvt aF <br /> re e✓u r l,F e IF <br /> � am ui,u <br /> o Y1/1 r ¢— }p i rtEGGf' zee <br /> :F od Safety Certiticab <br /> I Facility Hot Water Temperature' <br /> Name: Hand Sink: of Chlorine: ppm eat: -F <br /> Exp. Date: arewashing SInk: =F uat.Amm.: ppm ther: -F <br /> Received By/Title: f. /J/J <br /> EH Specialist: Phone: _ <br /> L � <br /> me in: Time Out: Pag f <br /> EHD 16-24 (2n pg) 4!3/13 FOOD PROGRAM OIR CONTINUATION <br />