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gyp°...'." "• C SAN JOAQUIN COL 'Y <br /> , ., <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.segov.org/ehd <br /> 4GI FO'Stta <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: 4�r Date: O_ I <br /> Address: (o C-1 I 0 r L, City: s� �n Zip Code: 20� <br /> Owner/Operator: Lu .Di Telephone: (� c5 <br /> Program Element: Program Record: p O I O Inspection Type: -7_ <br /> CQ <br /> SB180 Posted Yes F No Permit Posted 0(Yes 1I No Re-Inspection on or After: ��lJ <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> I ✓ rn ✓ L d45- r cU A CPP+0 i.c ✓r <br /> r- S r c� L✓L '� <br /> _Sa K i Y►1 O r �v) t�Qic�II' cs <br /> S V_P_ OL " hil r I Gi L, �7� L S <br /> Item/Location Temperature Item/Location Temperature <br /> --......... ------ - - <br /> I6OcF <br /> e s co r ho 4- 6 G J 6 [YL4'jK Go Ce r o <br /> jam.;iALa <br /> Food Safety <br /> Certification Facility <br /> Hot Water Temperature Warewashing <br /> Name: L ,,) Hand Sink: © of Chlorine: ppm Heat: of <br /> Exp.Date: $_A Ware w shim Sink: /3D of Qpatt..DAmm.: Q� ppm Other: of <br /> Received By/Title: <br /> EH Specialist: ^ Phone: 61 S 3 `.�81.7 <br /> c, _{ <br /> Time in: Time Out: 11 ,45 Pageaof 3 <br /> EHD 16-24 (2nd pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />