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.S'AN JOAQUIN LOUR <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209)468-3420 Fax: (209)464-0138 Web:www.so.ov.org/ehd <br /> <<FORa <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: NN o,� twv^ Date: Z 1 <br /> Address: v� ;` � S` City: Zip Code: <br /> Owner/Operator: 'R t �u Telephone: p <br /> Program Element: t% Program Record: fo*c;t)�_Sib Inspection Type: <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS = T= <br /> u' r ct l ,• c�.c., <br /> rCAA <br /> i <br /> �. i w=�Uv 5�►I� _ �f U u� <br /> u <br /> silt. a <br /> S► r.0 c, a rpvu . <br /> PAN fsv+, r/V1 L <br /> �J <br /> C4 = � <br /> V� <br /> Item/Location Temperature Item 1 Location Temperature <br /> c , <br /> 0rl MCu .� <br /> -kw jr) Nril <br /> a 4 - <br /> UO1SA t5 i o <br /> Food Safety Certification Facility Hot Water Te a ature Warewashing <br /> Name: Hand Sink: of Chlorine: ppm Heat: of <br /> Exp.Date: Warewashing Sink: of Quat.Amm.: ppm Other: of <br /> Received By/Titl i <br /> EH Specialist: Phone: <br /> Time in: Time Out: gyp\ Page of <br /> of JV <br /> EHD 16-24 (2nd pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />