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SAN JOAQUIN COUN <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East HazeIton Avenue, Stockton, CA 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.siqov.orcilehd <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />Name of Facility: &I ± 10 E 5 .2p Y-Le VJ 01'3 (j? -2— Date: :-72._ vo _. iv <br />Address: --6 s- 6 o /.\ j cA) c I 6 0 n tiu 60.7 City: 31-z), c„K itv...) Zip Code: <br />Owner/Operator: I o n (1 RA.5 cu ct I Telephone: -3,xci _-3-30 i? <br />Program Element --33 __.) Program Record: p AD 6 1--) 9 9 1 <br />Inspection Type: Ro Lci-.; <br />SB180 Posted s No Permit Posted es No Re-Inspection on or After: <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br /> <br />u3c,i4-t <br />bap [vo-P-e* - <br />116 b F 6-)cA‘,t ra_o*r <br /> <br />0 • 1.< s <br /> <br />Item /Location Temperature Item/Location Temperature <br />Warewashing Food Safety Certification <br />Name: —Mr) Pa 5 Cu a <br />Exp. Date: q,zig <br />Received By / Titl <br />Facility Hot Water Temperature <br />Hand Sink: <br />°F <br />Warewashing Sink: <br />i 6 ° <br />Heat: <br />Other: <br />Chlorine: <br />PPm <br />Quat. Amm.: <br />PPm <br />EH Specialist: <br />Time in: / <br />EHD 16-24 (2nd pg) 4/3/13 <br />q'(-0 t'ut 6)144 4"-y Phone: cm 3 8 <br />Time Out: /a 7,5 Page t o <br />FOOD PROGRAM OIR CONTINUATION