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°4"!" SAN JOAQUIN COUP <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • ..j ,.a�P• Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.siQov.orQ/ehd <br /> Lii <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: 21:JV <br /> Address: c> city: m, Zip Code: qc <br /> Owner/Operator: ►i N L 1 v Telephone: ,11�t '2 <br /> Program Element: �,2 * Progr m Record: F b I I r_ Inspection Type: <br /> �t <br /> SB180 Posted 4rYes No Permit Posted IVY es n No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> slird'h�- Vjnk- s ume 4 - ma011ne tac*- cfpMb (,ivo n <br /> CG C r S i <br /> Itetn/Location j Temperature Item 1 Location TemperaturE <br /> --- __ <br /> In (GOAVWwf <br /> 2A Vejfiefd U Sbve- Oc <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Ck�ha i,i� <br /> � `*Lib Hand Sink: 'F Chlorine: ittppm Heat: of <br /> Exp.Date: arewashing Sink: 1 , of Ouat.Amm.: [Z ;;i'- ppm Other: F <br /> Received By/Tit T�� <br /> EH Specialist: Phone: 2-to _ lj ig 44 b <br /> Time in: Time Out: LCL Page2-0f2— <br /> EHD 16-24 (2nd pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />