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SAN JOAQUIN COU* <br /> Q` ENVIRONMENTAL HEALTH DEPARTMENT <br /> W .. ;< <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • cq.. ;P Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.s'gov.org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: PJ i d K I e_5 Date: <br /> Address: City: Zip Code: <br /> ZS I W, G 4, � L;11 ►rc, C <br /> Owner/Operator: Telephone: <br /> Program Element: Program Record: Inspection Type: <br /> cC4 1. . . <br /> SB180 Posted Yes No Permit Posted - Yes - No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> i n i ron I Pro P G reok h y _ _l U ✓eA r✓1; n <br /> �ayse �r� u1m . lsea <br /> Item/Location Temperature Item/Location Temperature <br /> e V G r (�'dOo�� (� y/ <br /> S o o l N Ca rr cr <br /> G I (d;s to ill <br /> Food Safety Certification Facility Hot Water Temperature ,7.t Warewashing 3f c,v <br /> Name: Hand Sink: Chlorine: Heat: <br /> n' r) /OG 'F /6 L) PPM 'F <br /> Exp.Date: / _/ arewashing Sink: I of Quat.Amm.: PPM Other: of <br /> Received By/Title: �� 0-1/^/4-/L— <br /> EH Specialist: Phone: <br /> b b�•s�6d' <br /> Time in: /. Q Time Out: Page of Z <br /> EHD 16-24 (2nd pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />