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SAN JOAQUIN COUr,1Y <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> e Telephone:(209) 468-3420 Fax.,(209)464-0138 Web:www.sioov.org/ehd <br /> gtiFd'rl? <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: O ct <br /> Date: / `0 <br /> Address: u- v City: S•�v_ill Zip Code: 4! 20 <br /> Owner/Operator: q 'n n Telephone: <br /> Program Element: O topram R 5 R D 5 Inspection Type: <br /> ee r,���fa,f�•o <br /> 8180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> In - - <br /> \ Y Y <br /> -+ham O Lnch 01 V7 y7q e <br /> ✓� e 6t- re_ ID pe rk►-+ <br /> C-D OJVLA GoD )L4MLq ►' <br /> r0 OL. Yn.i L�o <br /> VI-0 l<-s -a- <br /> -k riI r <br /> ron-1- G lcza 43 <br /> r 14x_a. a� � vLch2 ' <br /> ro t - <br /> v\,-,c� d Iia n as e-,- ,- <br /> n R- - Kt 5 FC2 r- <br /> U r ✓Ytiw C>n ccs_A -_ <br /> o -Fo rc_. o YL <br /> -0c-, r A r n— IW23 T—e--e �1� <br /> "Item)Locaoon r Temperature Item/Location Temperature <br /> 2 84� ru r Ijv <br /> Aan r r4C o <br /> g <br /> 120 An kkl <br /> Food Safety Certification Facitlty Hot water Temperature Warewashing <br /> Name: 'Hand Sink: '1 /e, of Chlorine: Ppm Heat: F <br /> Exp.Date: �Warewashing Sink: J67of IOuat.Amm.: - ppm then. =F <br /> [EH <br /> eceived By/Title: r 1"" <br /> Specialist: ..Phone. 953— *7 O O 1� <br /> P <br /> ime in: X0, <br /> O i Time Out: / Pa of <br /> EHD 16-24 (2^pg) 4013 FOOD PROGRAM OIR CONTINUATION <br />