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oP"11N" SAN JOAQUIN COUP <br /> 'X ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • �4.. ;�• Telephone:(209) 468-3420 Fax:(209)464-0138 Web:www.sigov.orq/ehd <br /> �tFote'�i <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: <br /> rl Date: ,r ,_/ (92 <br /> Address: /�(�� - y�� City: jQj 00 1LJVN Zip Code: Cj 0q <br /> Owner/Operator: Pr IM I CW -Ck CjTi CA ,"vl Telephone: vl fn✓`.`/2+� h <br /> Program Eleme Program Record: D Inspection Type: ti N <br /> SB180 Posted Ye o Permit Posted es No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> r) ' c <br /> -Pit <br /> sm s n a� ,t7N � ib S W-S ok T <br /> 2 i"dL- CG S i -I in CI <br /> CM aV CA <br /> cs1F- �0 Issue, V im.mvy rZ_y 1'- <br /> mos ar.e <br /> Item/Location Temperature ( Item/Location Temperature <br /> ----- --- --- <br /> Food Safety Certification Facility Hot Water Temperature I Warewashmg <br /> Name: i - nd Sink: o Chlorine: P ;Heat: o(' —U t 1'�G�.� n U ��U F 1'r �C.� i � ppm --- F <br /> Exp. Date: ti / f Warewashing Sink: r� of Ouat.Amm.: PPm iOther: of <br /> Received By/Title: — <br /> EH Specialist: f Phone: 7-Oct _ Gcb �f i1 <br /> Time in: i0:' �t Time Out: r . .i v Page pf r <br /> EHD 16-24 (2n°pg) 4/3/13 1 FOOD PROGRAM OIR CONTINUATION <br />