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SAN JOAQUIN COUP <br /> Z, ENVIRONMENTAL HEALTH DEPARTMENT <br /> N: <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> ... . �P• Telephone: (209) 468-3420 Fax: (209) 464-0138 Web:www.sigov.org/ehd <br /> 4�iFO.R�.j <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: OY—YI 61 -Qi Date: <br /> Address: 2,0,19 LA—) m 61 r h L-Y) City: 6+0C4<­�rl <br /> Zip Code: 9 5 -.)-19 <br /> Owner/Operator: ✓ia C40%t Telephone: s�5_r)3(0/ <br /> Program Element: 16 O I Z Program Record: R/Wo S R 00 9 12 <br /> Inspection Type: <br /> is B 180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> --- - i ons C cin <br /> t ►11 1 2 <br /> 0 eed o fi-oo nd o \N + n <br /> hU cA <br /> Uv�► G 1c�r�l�.e --�-eS�- Seri S <br /> CX <br /> Item/Location Temperature Item!Location Temperature <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: �1{ Hand Sink: o Chlorine: Heat:F ppm °F <br /> Exp. Date: C C arewashing Sink: °F Quat. Amm.: ppm Other: 'F <br /> Received By/Title <br /> EH Specialist: Phone: 9 <br /> tp— <br /> Time in: /, Time Out: i Page of <br /> EHD 16-24 (2nd pg) 4/3/13 V 1 FOOD PROGRAM OIR CONTINUATION <br />