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SAN JOAQUIN COUNTl <br /> y: X <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> - cq.. t �P• Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.sugov.org/ehd <br /> L�POR� <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: l 1 <br /> Address: V MOM nazt— 410 -,e Ayam City: Zip Code: <br /> Owner/Operator: ��� / CJ!/ Telephone: <br /> Program Element: / /� Program Record: OcstZ Inspection Type: <br /> SB180 Posted es No Permit Posted - Yes n No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> `. L I r vl <br /> a "44,k GAs Gem&k X0 aev- A6t wt, <br /> a <br /> .( N G+o VI <br /> ibL <br /> hv <br /> C cv�e <br /> W17— <br /> Location <br /> j -- <br /> Location" Temperature Item/Location 777TTemperature <br /> orFooIvor- <br /> Food <br /> d Safety Certification Facility Hot Water Temperature Warewashing <br /> -- -------- ---- - ------ <br /> Name: Hand Sink: Yl] of Chlorine: ppm Heat: of filandif <br /> Exp.Date: Warewashing ink: 2G) of Quat.Amm.: ppm Other: of <br /> Received By/Title. L 1 C.„ ,, <br /> EH Specialist: �'1:'L � �tJ� Phone: f,�G�' <br /> Time in: 9 Time Out: Pagd2_0-f <br /> EHD 16-24 (2nd pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />