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SAN JOAQUIN COU <br /> a 'X ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.segov.org/ehd <br /> cr�oe <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: -. rr ` 2g � Date: /—;?D 11:5 <br /> Address: 730 C 64 -ric 4 City: ,5-/t)C./�L- `J Zip Code: pe�� <br /> Owner/Operator: �M ; o{-� C 7Telephone: 1 u3_C7Q3 <br /> Program Element: / Program Record: �00 391'17 Inspection Type: J <br /> SB180 Posted Yes No Permit Posted FYes C No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> Y-0 F to r -)_ r i. m <br /> L <br /> r ovlr -04n ;t fKV m Ce c d i 125 <br /> J n <br /> i <br /> r r%ee-+i o yl r ' » to aX <br /> ���Lug c.�.� a-•l•- a lel -1-i mp s . _ <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 Quat.Amm.: PPM Other: of <br /> Received By/Title: d quesre lv <br /> EH Specialist: Phone: 953` 1-7 <br /> Time in: ` •, Time Out: a� Q Pagel of + <br /> EHD 16-24 (2nO pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />