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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.sjgov.orq/ehd <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />Name of Facility: / 19 IrPOW bit -41- .1- 0 .--CiEr- O Date:1 ,1 -7 ‘,, <br />Address: a.1 4, cit i 1 A A ,.; VI <br />City: ak <br />Zip Code: (1c( <br />Owner/Operator: <br />4i(AZ(11' 4—i PIV 9-- <br />Telephone: <br />Program Element: <br />)0 <br />Program Record: 12.__D c -Y-77 tt, Inspection Type: 1 <br />C Permit Posted Y No Re-Inspection on or After: SB180 Posted Yes No <br />.3 \ <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />'Po 4 si 1; Lulu ss nou u-vvywv 1 WIMP/ 8141,1 E‘i-744€ 1- ---v p <br />an -if2-ucx- <br />P\vi4.71-irty irisfef-tuyi. (]o nitiquv viola-ftmc, Ak <br />0 1,11c19e MI 15Y1 <br />D K 1-1) I cs Ike 2_o -Lc pf2MYud--- MCe. 19w4A71 <br />cee (C gAld/ <br />Item/Location Temperature Item / Location Temperature <br />Food Safety Certification Facility Hot Water Temperature Warewashing <br />Name: Hand Sink: o F chlorine: ppm Heat: <br />Other: <br />°F <br />Exp. Date: Warewashing Sink: .F Quat. Amm.: ppm °F <br />Received By! Title.< i. 1 <br />EH Specialist: <br />.12/4'z-- <br />Phone: 75.01 _61 6-3 bifb <br />Time in: Time Out: Page 1 of / <br />EHD 16-24 (20 pg) 4/3/13 <br /> FOOD PR RA <br />C)05 LA