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SAN JOAQUIN CORY <br /> �.• cpc <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.segov.org/ehd <br /> �/FORD <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: o r r R Date: _13 -I y <br /> Address: 3-7O$ ' 11C"� �� City: 0CX_*& � Zip Code: 015.1 q <br /> Owner/Operator: �kQA �✓ Telephone: -. <br /> Program Element: X�O-40 Program Record: P1��G�-Z�cJs� Inspection Type n'e— <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS [� <br /> 0�--�c�� "Ac Yl C X � �o Yl'Zi f>> � ��L 1 C� C�� J��A 50,V'_ P r a Iri,qLl � <br /> + i mt- <br /> g �Y-0.0 Y" f Lo o,rs V-+g.ie F-r e-Ly-d c)-F-f n CL,. �k �2l -r Pot-L-4 e 40 Y�- <br /> Y�-t*+ S C_at so n <br /> ck <br /> F00 A a 1 n cle r 5 re - -1- <br /> Y Yrti i <br /> Y d nn fvoJ CA Y-9- 60 0 r SR <br /> 5 W re- <br /> a e <br /> F't S -6 D K.. (q C-q— d 'j r II Yt O O ) t-rL L O <br /> Item/Location Temperature Item I Location Temperature <br /> rr-ru✓ GrZ u ear�► <br /> r Food Safety Certification Facility Hot Water Temperature — Warewashing <br /> Name: Hand Sink: t.,X0 of Chlorine: ppm Heat: of <br /> Exp.Date: Aw o g Sink: -'LD f Ouat.Amm.: ppm Other: 'F <br /> Received By/Title: Y"*n C_N Lx-91 <br /> EH Specialist: Q� 1_ Phone: 015 3 <br /> Time in: S Yw� Time Out: 5 Page of I <br /> EHD 16-24 (204 pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />