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SAN JOAQUIN COUR <br /> 4 ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax:(209)464-0138 Web:www.sigov.orglehd <br /> LlFOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: ` S Date: 1' )0' / <br /> 1 <br /> Address: 3 0 CityZip Code:rangy' L; : Tuc qS 3 If- <br /> Owner/Operator: DOINTelephone: <br /> Program Element: 16) '1 Program Rec rd: S 0 3? ) Inspection Type: R <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: 2 <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> a-___ <br /> } _ C o Ve rS n 04 i /1 d l4(e . "7 I//,. W's <br /> ro o d a r o A e 4 s I U e I( 4:'"d_� r is ----a.I _� <br /> _..... C on-1 AS ewr3 ha rt dl,,( Ch ease a Ibe J•1 crr1 O r C-0e) 4qr r. <br /> PfOv; ale Me la 6 elS uJh,'n_ -Cao ./ ;s "4 vn <br /> � hC r\ It SQ 'ntt4) (tvt4o . -Cr Ter Chars <br /> r r r C�e d ------- <br /> 3 C� a Ill'- u on / �h, T106r5 L if; de <br /> y f Wc SII �Gl� - S n ;J;zPr DC'rk"e f pr e C : ri <br /> C6 r r,+c •If <br /> S FqC ; I, s 4or;n g e i b a C K Romeve a3 <br /> 6 PerSo – '� !�- Char c S �� r1rQ An 4 ;Zer <br /> -� i hl 1.5 -CC P h c4 t r S . 5 G'n 1 Z�—,� 2 V e r fl o r S <br /> f Iroc,,yi has 4o, I rr 6 4 a r _ <br /> d 's D P r\5 e r, (r'rrrCj -1"Olav _u— <br /> n G I Z 40 eej W ar r✓l WA t o vl 4 fml 1,r: r e S Jlr oc r'1 <br /> Sh.0r-r Prov; le 1pgp,f Idol ler, CCrre, J -lode <br /> ItemtLocation Temperature Item/Location Temperature <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> ---— — _.. .. ..... <br /> Name: Hand Sink: °F Chlorine: PPM '�Heat: F <br /> Exp.Date: arewashing Sink: 'F Quat.Amm.: PPM her: °F <br /> Received By/Title: <br /> EH Specialist: ./6 •��6� <br /> Time in: 10 �). _Tit6Out: ! Pagel of <br /> EHD 16-24 (2n°pg) 413+13 V FOOD PROGRAM OR CONTINUATION <br />