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oP41'" SAN JOAQUIN COUNO <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • �;.. ;P• Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.s*gov.org/ehd <br /> �IFORt� <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: !1 e wl ce1 4 VCR Date: a— <br /> ddress: ,�` L r 1 City: Zip Code: q,fir <br /> Owner/Operator: +.e Telephone:00p 3 15—3 3,35 <br /> Program Element: I I ProgramRecord: n Q rJ L� Inspection Type., <br /> F61_80 <br /> Posted Yes `o No Permit Posted Yes 1`No _l Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> f U11Ch re S <br /> -- tkJj-�e r r <br /> lob ld <br /> i a& 1h s n.�o-f- rea h - K - <br /> ov, <br /> no o� rn <br /> - iOL C0 <br /> i <br /> - r <br /> ni D ro <br /> aA-e ►� . Pro <br /> =�f r i rS a r2 r 12 04 ­K01 (41 Q_-a <br /> e I✓ " -r- <br /> r r S©c ICQ_ <br /> i� -ems d n Ln , <br /> Item/Location Temperature Item/Location Temperature <br /> r c.o6Ca r u q4r <br /> 2 1a r <br /> Fi3 d��Safe da ion'" Facility Hot Wader Temperature Warewashing <br /> Name: Hand Sink: of Chlorine: ppm Heat: of <br /> Exp.Date: Warewashing Sink: of Quat.Amm.: ppm Other: of <br /> Received By/Title: <br /> EH Specialist: _ f _ Phone:oe 53 In <br /> Time in: �= Time Out: 1 Page of <br /> EHD 16-24 (201 pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />