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SAN JOAQUIN COUNTY <br /> Q` ENVIRONMENTAL HEALTH DEPARTMENT <br /> N: :t <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • c... �P• Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.segov.org/ehd <br /> 4�jFORea <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: i Date: <br /> ��1us <br /> Address: [L e f „� City: � Zip Code: <br /> Owner/Operator: r� -e n ri G O Telephone: j�"70X/ <br /> Program Element: A000 <br /> Program Record: CO 0 <br /> +nO —7.7 DS- Inspection Type/D,IS �• <br /> 8180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> 1 U;L I/1 4,r -/CA 4 f L 1� U r - <br /> L �,e r <br /> r q -! g <br /> Lo t. -� who 4- � <br /> t�•-I f . '--IQ Ax -l-c 4k6t-4- a o <br /> KtoVol rweak &-n 41-C 9-C- <br /> .4 <br /> A 5I �►-�s <br /> L-e r 4- of U_ -f-� <br /> a re- f A <br /> v� <br /> Item/Location Temperature Item 1 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 Ouat.Amm.: ppm Other: of <br /> A <br /> Received By/Title: <br /> EH Specialist: Q Phone: 9 5 3 <br /> Time in: Time Out: h/ / Page/of / <br /> EHD 16-24 (2nd pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />