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oPg..coG SAN JOAOUIN COW <br /> Z� ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax:(209)464-0138 Web:www.s*gov.org/ehd <br /> �/FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Iill Date: /2 <br /> Address: <br /> City: Zip Code:j ! �vrCuJt� � � �/ ��� �tir„ � 1:Ss.SU <br /> Owner/Operator: Telephone: <br /> Program Element: Program Record: Inspection Type: <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> ni Thaw 'n a o r,C/ s;n K. <br /> S' i nn o r ,- Qr <br /> ;n o 1 r1 0 s; 10W4 <br /> 2 d s: ,iK r ' 05 unoln.ne 0A64 /G►CKs ldC-4.1n7 <br /> C4 i ✓YIe � � <br /> C . r? I Sc co r n1 n are co . <br /> R f* C tP� i dus ct/-.* � <br /> So.- de, lil-C A r, 16,61A I G <br /> dG kX rtf 17 10 (e rS C ;hf <br /> lice "'d i n balh I^(' ro 6.6 <br /> Prrj re ft; 4c.- n I /V y' <br /> rV <br /> �. dor 4 V <br /> C <br /> �Q Grrp <br /> 1"l G Y,ale Cl 0 I/P r d VP r- G N GAO C., re i' s <br /> 0 rrel : n r0c, 1A <br /> U <br /> Pre p 4 U 0j G bro Y en 1; d hQ ^ 6111 6c r.,r e- <br /> r rdo MS q C K SP /� 5 r,T We i n 2 We e K.1' <br /> ocation Temperature Item/Location Temperature <br /> --- - empe <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: 4, 1C of Chlorine: PPM Heat F <br /> Exp. Date: arewashing Sink: of Quat.Amm.: PPM Other: of <br /> Received By/Title: <br /> EH Specialist: Phone: <br /> 3/6 y <br /> Time in: Time Out: 2.5 1 Page f <br /> EHD 16-24 (2ne pg) 4/3/13 1 FOOD PROGRAM OIR CONTINUATION <br />