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SAN JOAQUIN COUNS <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.sogov.org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: 9 q f l rres S Date: <br /> Address: 6© L City: LD <br /> I' Zip Code: <br /> Owner/Operator: "'l / r Telephone: <br /> Program Element: / ©® Program Re rd: �� db Inspection Type: <br /> SB180 Posted Yes (o No Permit Posted Yes No Re-Inspection on or After: <br /> s <br /> -v _ _3 7LtR4" ) QA <br /> NS <br /> - <br /> vc-cw 6 bes a the <br /> Ter fS c.vh.-f `n o <br /> o n f v 4-S cbS2ry yr wc,,ryA ousA- <br /> / S OIMQ� cc 1"'o o a- <br /> 0 r <br /> ve o v\ t,►t I d <br /> l 5 <br /> r vert S �( 4AA_ <br /> 4 R� r�V C'vr bwi� S P l v"es n rvuaee C , /,^q Cir ,, , <br /> v <br /> O ewe. *ao 1 0-( 4rasl, wgsoto ve. 7,N h axS-Z c- <br /> oL I 30 s l-4--/ rv2,( i-�- <br /> n rlQ jl i tn-.l PrpL, e"Q ;!!, re 065JZr v e - <br /> 2Pv^� v e -�rcav►� t ,^e /1�c %n.�vhe ck- 1 <br /> �. f ✓Y� <.:arl/�ctZ <br /> a Kr Q ca r slo 4� c Ll r '3 341 e re^C)%jC'- 1' S <br /> �1�G /!'1 �✓O c/� T_�;����i��.+, t--� 1 � �'r� C.CL'f-1v� <br /> Item/Location Temperature Item/Location Temperature <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: of Chlorine: ppm Heat: of <br /> Exp.Date: Warewashing Sink: of Ouat.Amm.: ppm Other: of <br /> Received By/Title: p RAA ) <br /> )wvl�l CMai <br /> EH Specialist: „ J Phone: (J _3 ��- <br /> Time in: l 21. I u Time Out: ' ,C c) Page jofr <br /> EHD 16-24 (2nd pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />