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,g� •.�Ao SAN JOAQUIN COUN' <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax: (209) 464-0138 Web:www.sa-ov.org/ehd <br /> <<FaRN <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: ) � _1�E, -'- �# Date: -2- <br /> Address: <br /> 2- <br /> Address: - S W , I Ln City: 5 Zip Code: 95-ZU <br /> Owner/Operator: t Al--L r <br /> ,ter Telephone: 9S•'„ 3 1 5- <br /> Program Element: ' Program Record: �'�®3C Inspection Type: O LA,4-1 r1,¢ <br /> S6180 Posted )(Yes 11 No Permit Posted es r7 No Re-Inspection on or After: <br /> a °mow. <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> C43'w/e a^S o t`d �rseG� Ki Ilex o(�serJtii . fG,,L <br /> 3 C.D -sink, ikse ®n( re <br /> iA -ro5� onh�i'o me .o <br /> a c3-r � ►Jc <br /> Snn^Q M11F aY`$ 4,Q s'Qt-eJ Q^ 4r (coar <br /> Sim OM t-fws (arl I O 4Vt- -r(,o o r <br /> Item/LocationTemperature Item/Location Temperature <br /> ---- - -- -- <br /> COY-^ Doc4,s 74 �50_I Ic _ <br /> Food Safety Certification Facility Hot WaterTemperature Warewashing <br /> Name: e , r Hand Sink: , of Chlorine: ppm Heat:Otherof <br /> Exp.Date: _ !3 _� arewashing Sink: ! 3s of Ouat.Amm.: ppm : GF <br /> Received By/Title: to$e <br /> EH Specialist: (_ I 1 _A 1 Phone: Y(ba 3y y S� <br /> Time in: �G,Y���4G 1~J Time Out: , 3 PageZof Z <br /> EHD 16-24 (2nd pg) 4/3/13 FOOD PROGRAM DIP CONTINUATION <br />