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SAN JOAQUIN COL Y <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.sigov.org/ehd <br /> Ci ij <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: 1l v'/_ k-1 Date: S'Lll�c I <br /> Address: r , Hrloen City: j �iG{r' � Zip Code: <br /> Owner/Operator: kq (✓/ Telephone: <br /> Program Element: ftdgrarn Record: ©/6,7 6n S Inspection Type: <br /> SB180 Posted Yes ( No Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> (J rJ a 7h-t vt 1 -�z✓ <br /> Meeh — <br /> e a v� b-c��► C'e►ivy- <br /> c Ct✓1 f t� �h �U�e✓ Cdr <br /> 4durwwc7 �t wl <br /> ci! -lf I rl <br /> 1 ,n i l��v►�- <br /> `Temperature Item Location Temperature <br /> Food Safety Certification Facility Hot Water 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: J , �1 f? Phone: , <br /> Time in: �1 I t/ Time Out: O Page of <br /> EHD 16-24 (2nd pg) 4/3/137 FOOD PROGRAM OIR CONTINUATION <br />