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,oP4 .�oG SAN JOAQUIN COUN- <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • c... :P Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.sogov.org/ehd <br /> 4C]F�.�ia <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: �� Date: 9 <br /> Address: o �HCity: / _ ! Zip Code: 4�^� � <br /> Owner/Operator: r claNG� h0 l� C�.�3 Telephone: <br /> Program Element: Program Record: ` La o(3 ,j 3 Inspection Type: <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> � L K 0BSEA 113NS At 0CP 'RE T1VE ACTIONS <br /> z <br /> tA <br /> S s = ( cgs�•�_er s nest, t'L..Q <br /> I5 ^& ^-arlP 'E .d S•e it (GL L t 0 f 1'5rS <br /> � `tin / Cc re—a ca <br /> w4sh 07 <br /> A c c t e6a d +AI s I'S t h e c.)rrec C <br /> Is c+lWa �0_ `fir c a Lk,4er- Re S0 <br /> at" CA� c z,= or d r- aces I ka— caclQ 1c1-s <br /> cc.w r1-1 <br /> rzof�or, 'EU c� Go. ^ r i XXX . <br /> ki 2r 5e 6o.A y kgre_ r-rnc /'S kin Ifs <br /> hand I��. -1-ecG, s rn lAXJe- f --dwaSh rs�c <br /> l S er .. <br /> c .1 0LA t VIV, . <br /> Item/Location Temperature Item/Location Temperature <br /> Foos ;Certification Facility Hot Water Temperature Warewasfiing <br /> Name. Hand Sink: 1400-t— 'IF Chlorine: ppm Heat: of <br /> Exp.Date: Warewashing Sink: of Quat.Amm.: ppm Other: of <br /> Received By/Title: <br /> EH Specialist: P one: L'/6 <br /> '/ V-3 <br /> ._ y �- <br /> Time in: Z Time Out: 120-5-- Pagelof( <br /> EHD 16-24 (2nd pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />