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SAN JOAQUIN COUP <br /> Z� ENVIRONMENTAL HEALTH DEPARTMENT <br /> u): .. X <br /> _ 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax: (209) 464-0138 Web:www.sogov.org/ehd <br /> �/FOfta <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: bj 1 ^L I Date: <br /> Address: h ry �L j2 City: yo(A"N Zip Code: <br /> Owner/Operator: �'1 S,'Y' 0,_ jai) 1L,�,- r : �1 N(— Telephone: <br /> Program Element -�y Program Record: 1- r 1 Inspection Type: 1 � v <br /> SB180 Posted Yes No Permit Posted Yes No `E� t Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> el- S Ler C Q 1 e i W411CA .Sun f� <br /> � . NA (,aVE 1 02-1-b <br /> Cu rvp a 1 eTr ml A- ho-1 v cAi a <br /> OlS :e re rn i t G i 0 Cu <br /> r� <br /> iteriV ovation Temperature Item7location w Temperature <br /> F �.,� i i�U l �' i X11 fi�� "�G '�„— - —f u+► l v��+' I (G�Q5�2�"-+ �'`r= <br /> Sa U'-Ct (u uv 4I <br /> I r r ��c..e SGIa 3i� <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: ° <br /> J Chlorine: Heat: <br /> t-'� F ppm °F <br /> Exp.Date: Warewashing Sink: °F Ouat. Amm.: Ppm Other: °F <br /> Received By/Title: /G+ c-wv <br /> J r <br /> EH Specialist: Phone: /1 �1 _ G <br /> Time in: /I Time Out: �yt�J s + U Page2of 2 <br /> EHD 16-24 (2nd pg) 4/3/13 1 FOOD PROGRAM OIR CONTINUATION <br />