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oPQhl" SAN .10AQUIN COI. \Y <br /> �.. .eoG <br /> :y <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> R = 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web:www.sigov.org/ehd <br /> CjFp[tt1 <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: -Vrl OY 5. Date: <br /> Address: q O 4 LA-) t✓4-ey�n 4 .5--E City: 640 -fbn Zip Code: y,7-V a-, <br /> Owner/Operator: Telephone: <br /> t1a.-�i On � � K� 607-- 5-097 (oo-7-5097 <br /> Program Element: �1 rogram Record: 0,5 -Zo y7%110.2qG 41 /q(o Inspection Type: +` C 70r) <br /> IS 6180 Posted 0 Yes ❑ 'Permit Posted ❑Yes ❑1 Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> P A © 5 �', 69 o y W s. ---------- - - - <br /> LID 4- yj 4e+- ©.l-e r 12th F <br /> KI a l l n2o .5'1—K- We e,e_ r-e- e", -.e_C4 <br /> R d 5 a_(0,0 L1 I C: PO r,Lt', <br /> 1 D', 'r' U-n n W ev] <br /> -k P roV'+ a�Q_ 10tc✓ <br /> 0 5 r Pt-m1-e. <br /> Imo + yJa4e r ov r I <br /> Id Y V <br /> yj O a_f. 'S co h i o- O ii U ✓,-2 C,_ <br /> S a4- aTO 12 14C W2 P-e r�eCt i ^Q <br /> Item/Location Temperature Item/Location Temperature <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: of Chlorine: ppm Heat: of <br /> Exp. Date: arewashing Sink: of Quat.Amm.: ppm Other: of <br /> Received By/Title: - VN1 ; I� „ <br /> EH Specialist: /„�'V,✓- Phone:il 0 <br /> �� t i +� 1� q� 3 g.- <br /> Time in: �). j 0Time Out: Page (of <br /> EHD 16-24(2^'pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />