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SAN JOAQUIN COU* <br /> Z, ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.sigov.org/ehd <br /> 9�/FO.RtN <br /> ,FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: L f h J-CV" W Y7 Date: <br /> Address: '-4 <br /> �to <br /> Opiy City: S l_ �+* 11 <br /> 1 Zip Code: <br /> � Q <br /> Owner/Operator: ' O—h. r•1 5 6 �� Telephone: &yy_lq 1 D <br /> Program Element: Is Program Record: P R 05 3 5 Inspection Type: <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> o n %✓1 opf ra-ho n W i+Ji o Lt+ 'cl <br /> It a s u re <br /> �k C_0 K5 0 l 4-0L+7'o' 9 12 <br /> *- c r.--�.4 -e.c ro 'l 00 <br /> .,W SJ �d4 <br /> L <br /> r .� <br /> Item/Location Temperature Item/Location Temperature <br /> WaagA An 5 b <br /> It q o <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> -- -- -- ...... - -- <br /> Name: Hand Sink: r D� / I of Chlorine: PPM Heat: of <br /> Exp.Date: Warewashing Sink: j C)4 of Quat.Amm.: LtO ppm Other: of <br /> Received By/Title: <br /> EH Specialist: n e Phone: '46 <br /> `-78 `? <br /> Time in: 10 . Ll D c� 0 Time Out: 11 ., 10 <br /> Pagel of I <br /> EHD 16-24 (2nd pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />