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SAN JOAQUIN COUNTY <br /> 4 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.or-,/c/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: P,orb 4�-, P-e �,tCAu I- on�- Date: l v IV <br /> Address: `G q L 97 i1.__ v� City: h_1 n,n Zip Code: q 2 <br /> Owner/Operator: W601 �r� Yra�cA a C.11� Telephone: 1 <br /> Program Eleme (p 2 Program Record: ('0 ( � j Inspection Type: <br /> SBI 80 Posted Yes No Permit Posted Yes No Re-Inspection on or After: �Q <br /> OBSERVATIONS;AND CORRECTIVE ACTIONS <br /> i "(hem-e Grpr6�0 <br /> au n i M_�TlLrnQ,n� -- <br /> __...-- cel 1 cG16 Ur C-=- QP.n _ _.._. <br /> fiU S <br /> I S G k vJ(- OA Pka - tAA u n Q0 <br /> S. C urn QS .Scan S a - 1 s t , <br /> FdCitSi T)Y- Orz -\ns•( jTv- &Tv,�P-r <br /> C"�- ADO <br /> C01 '11� i _n offC,hC1r _ fn <br /> Gt 'IS S rLCC fi tV CM f <br /> -Ie�MS c�wRv fR� C�fi�i o0� S f_ <br /> 0 -soap I <br /> �,urr-�n-� c• t-�c�sn `s ��c�c�le r`s C�r�s S <br /> Item/Location Temper ure "_: Item/Location Temperature <br /> ...........-----�._v_._ �__ _. _��--— — ._...- <br /> - ------- <br /> G� kA. <br /> ria« in <br /> or <br /> Food Safety Certification i Facility Hot Water Temperature Warewashing <br /> Name: j �y Hand Sink: <br /> L l'0� u VC(�,��L i✓L, of Chlorine; ppm Neat: �F <br /> � t P+SCK i ( ___----_ <br /> Exp.Date: j � ; (� arewashing Sink: (,_0 -F Quat.Amm.: PPM] <br /> pm Other: o f <br /> Received By/Title: <br /> EH Specialist: Phone: <br /> Time in: 1 0 , Time Out: i ;�!" TJ Page�f <br /> 1 O <br /> EHD 16-24 (2^ pg) 4/3/13 FOOD PROGRAM OR CONTINUATION <br />