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P k.RIIy SAN JOAQUIN COU. f <br /> .goG <br /> -� ENVIRONMENTAL HEALTH DEPARTMENT <br /> W , :< <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax:(209)464-0138 Web:www.sigov.org/ehd <br /> ;iFoaa <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: lq Q-5 Date: -7 <br /> �J <br /> 1City: <br /> Address: (L4 �y 9 N � L Dor2xCyO � � City +0 ,+.QP, zip Code: T 20Z <br /> Owner/Operator: b 9P__ <br /> Lot- Telephone: 3.a 41-(o"496 <br /> Program Element: I(,9/4 Program Record: n R O 02 34 Z Inspection Type: ^Po J-h n� <br /> SB180 Posted Yes ❑ Rermit Posted t' Yes ❑1 Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> � S <br /> wso4 "i haa d %--ir- . K -e <br /> r v r -to av-e-ls . 640re, irk <br /> ter a •res doter <br /> Un co Ve r.a Pro or- <br /> 132 r <br /> rn tr � ' f Loots <br /> roz * m o v-0- ro v-�cic t"v r-e- <br /> XL / r <br /> a­ 4,4 6,e, -0-0W-C, coo .3 a re- e,-7 5 A0Yr d,,'h <br /> W r , -,? 4-e) °F orw-e. r / . or <br /> WG r'a- shag <br /> act Oc-;1,0- 4 <br /> dF <br /> Lot r e'o v4e- r A0 v-e- r <br /> 4mI <br /> Item/Location Temperature It m I L,oc¢tW <br /> >r La-K� �' ve ri v- C-c- <br /> Abi <br /> C,0— ! q517 eP cA �3 <br /> Wme; jejq r�_oFood Safety Certification Facility Hot Water Temperature fWarewashincda /a (Hand Sink: /� °F ;'Chlorine: ppm 'Heat: `F <br /> Exp. Date: 130 <br /> _ . 1Narewashing Sink: F Quat.Amm.: ppm Other: °F <br /> Received By/Title: <br /> EH Specialist: Phone: <br /> Time in: Time Out: 11 b 0 O Pagez.2f <br /> EHD 1624 (2nd pg) 413/13 FOOD PROGRAM OR CONTINUATION <br />