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pP4�IN p SAN JOAQUIN CO. <br />` ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />�4i/F a;a Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sigov.org/ehd <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />Name of Facility: 1(���/�Q 1..t (fL sJ <br />Date: <br />bl c(o1 :1— <br />Address: }1(6 (1114City: C <br />1� zip Code: LIS v32 <br />caner/Operator: tpoojaa1OrTWI(O <br />Telephone: <br />,Tf_5 <br />�eWj <br />Program Element: Program Record: b 1 � <br />Inspection Type: <br />�{ <br />B180 Posted Yes No Permit Posted Yes No <br />Re -Inspection on or After: <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />1 V.etY,1�r 15 �eliiR UhUG <br />i I cvn i <br />R� S <br />u LA- A( -e -- L06ZI a <br />LOW <br />C <br />i cm <br />De S U <br />SSC <br />W !1XMb(A(AGYQ 0A_ CA <br />I <br />P�rh•� <br />GI�E� <br />S <br />Item/Location Temperature <br />Item / Location <br />Temperature <br />Food Safety Certification Facility Hot Water Temperature <br />-Warewashing <br />Name:- Hand Sink: ,F <br />Chlorine: PPrn <br />Heat: <br />of <br />Exp. Date: arewashing Sink: of <br />Ouat. Amm.: PPM <br />Other: <br />of <br />Received By / Title: Z� 171 <br />EH Specialist:Phone: <br />�O U <br />Time in:Time Out: <br />Page of <br />EHD 1624 (2^ pg) 4/3113 FOOD PROGRAM OIR CONTINUATION <br />