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,QP4u!ry.F, SAN JOAQUIN COL 1( 1 <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.sioov.or0/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: _ rcI'ot <br /> Date: r -:)z <br /> _) <br /> �J <br /> Address: 1 L . , 1 City: G L Zip Code: pl,c <br /> Owner/Operator: 5 �lJ VlJ J Telephone:�p,. <br /> Program Element: Program Record: n n C)4) Inspection Type:—)26n ,j-H rLe— <br /> B180 Posted O Yes P0 Permit Posted O Yes D No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> l) LJ-1 YrU OC f e-.41 <br /> fI,OOy-S . �n d Z'�kA �� Co L <br /> yf'- :%Er <br /> v-e- jp La of rrn.,'-f 6-14e <br /> e. n s,1' <br /> lrl FixTgo c Efo• YraorI L5. ho ou! 0:(ab Ice <br /> 642 cA <br /> Item/Location Temperature Item/Location Temperature <br /> Food Safety Certification Facility Hot Water Temperature _ Warewashing <br /> Name: and Sink: "F hlorine: Ppm Heat: "F <br /> Exp.Date: arewashing Sink: "F uat.Amm.: ppm ther: 'F <br /> Received By/Title: -2 <br /> ^ <br /> EH Specialist: / Phone: q5 _7 <br /> Time in: 2JTime Out: 9;1/5 <br /> ; Pag9 of / <br /> EHDI624 (2-P9) 4013 / FOOD PROGRAM OIR CONTINUATION <br />