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SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East HazeIton Avenue, Stockton, CA 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.siciov.orcilehd <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />Name of Facility: 0 1-3‘i t 1 b1/4.04„L2 <br />Date: <br />City: <br />t)/kil <br />Address: <br />k WI WI <br />("4-piv Zip Code: ? OS <br />Owner/Operator: • <br />' <br />Telephone: <br />Program Element: Program Record:(1 V---0 5L+SI qc Inspection Type: id7 fir& (41 <br />SB180 Posted es No Permit Posted es No Re-Inspection on or After: <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />+SI-Di s4 yu Att a A Mot/101i 0), Lo in J -Le s- 66-b <br />/4 1 IP <br />4 ?oc<-\ 512i150 5w -- <br />al tn99e0-tin. III) trykitliuv vefikA-L6Y)-5 <br />Y ) (,e - 1 ncene-ecA-T-Aci <br />Item/Location ] Temperature item / Location Temperature <br />Food Safety Certification Facility Hot Water Temperature Warewashing <br />Name: Hand Sink: .F Chlorine: PPm Heat: <br />Exp. Date: Warewashing Sink: °F Quat. Amm.: PPm Other: <br />Received By / Title: <br /> (9c n 7C(16---- <br />EH Specialist: A <br />Phone: (0 t 6-3 <br />ime in: 1 001 <br />Time Out: — to 01 01 Page o <br />EHD 16-24 (2^, pg) 4/3/13 FOOD PROGRAM OIR <br />