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�P°" SAN JOAQUIN COUNTY <br /> �. .o <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> Telephone;(209) 468-3420 Fax;(209) 464-0138 Web;www.si4ov.orA/ehd <br /> �f FORN <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: D `-5 Date: <br /> Z_Address: i n T h 5 City: rG Zip Code: 175376 <br /> Owner/Operator: ro v,S rub Telephone: F-3 I Z-zoo <br /> Program Element: /_ G 1 Program Record: S oO /(O� .l �7v1 ?- Inspection Type: i a ' <br /> SB180 Posted -Yes - No Permit Posted - Yes No `1' Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS I' <br /> iN h a r 1,n ,n <br /> h o rCt'J -fee <br /> 5 Ci C4 C, Ire S r; l r <br /> 0 r\ a rrtc4- G n'- :n <br /> Ci CA <br /> rYl O Hca re.j ► n <br /> S G a r�o <br /> �/ <br /> I'C' r c lee h 14 f� <br /> K s / G C K S_,j 1 Z5 0 6, CIS. I G v i rhe <br /> K. <br /> C \r i r, {c7 Kno d r SIge R G ;r i n <br /> 1 K . <br /> q e54roc ^'►'S Odr -,5 r) A / S C/05` %h <br /> a rata do of hr C o ti 4e <br /> iC � ►'� ► r\ �O <br /> 0. \, Br M. Qr) i 14, yo <br /> UC' been a ;•I r r` (, }� e r Y ro; <br /> Item/Locatio. Temperature_aite_m_/Location Temperature Item/Location Temperature <br /> 1 ' in 0 / l <br /> re Nh1e 3Sl ay Lbic 3rIF <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: ° Chlorine: Heat: <br /> !/ ✓,s l'J f �� J. to G v F ppm °F <br /> Exp.Date: - _ c arewag Sink: R30 o f Quat. mm.: ppm Other: 'F <br /> Received By/Title: J <br /> EH Specialist: Phone: 41 t, <br /> Time in: S Time Out: J Page O� <br /> EHD 16-24 (2'l pg) 1/18/12 FOOD PROGRAM OIR CONTINUATION <br />