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,oP4 .�oG SAN JOAQUIN COUP <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax.(209) 464-0138 Web:www.sl4ov.org/ehd <br /> L�FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: ` 0, i 0 _� ��,�1 I I Ck� Date: �p12 I <br /> Address: 2 G 30 � �U r City: � Zip Code: �2U j <br /> Owner/Operator: J i o ` „ n-) - Telephone: ��� _ /i(;b <br /> Program Element: ( � Program Record: b GG / Cj 7 G Inspection Type: -T� "1 <br /> SB180 Posted Yes No Permit Posted Yes No `D Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> (ri 1& S QOM (.CN i n 1 1 AA GU r�- CA <br /> % 1- -WCa KS wifih -AA " Give- <br /> t la UV 111 G <br /> " <br /> v-jc G �O f - c10 sAm\v co no Ye S f-fzm dco-r- <br /> ht(� MDQ Un 5 <br /> Tl cNi,cta U 'FooU�) 's sq c2/rfiif COW- COAa <br /> ON1 I ee s by o �( r wifih ,tl <br /> UVV�n <br /> � i� cm O�Qir wUt�ts c�e2 � �S Get fid. i� a� <br /> 'i CA "DocA <br /> - 0 1 Ste, FelTld ali-W A182.,, o_� 4P--300 'IS <br /> Yv 0oo rJ N S�I - o'� W10 <br /> 1 23 a W <br /> .a <br /> CII" Ty VQ.� �� 0 C;t <br /> iia Slfl� ' 2G <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: U of Chlorine: ppm Heat: of <br /> Exp. Dat Warewashing Sink: I•Z G of Ouat.Amm.: ppm Other: of <br /> Received By/Title: <br /> Av <br /> EH Specialist: Phone: <br /> Time in: Time Out: 1� Page of <br /> EHD 16-24 (2nd pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />