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SAN JOAQUIN CO, fY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjqov.orq/ehd <br /> <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />Name of Facility: y-v-\ wirtii_Lzi-j I.), jz, 4 ki j k. It 4,1 61 Date: // j3//-) .4d-- <br />Address: Zip Code: 3c co vtlAtikart i/A:i City: <br />Owner/Operator: Iv\ v _ it (t Telephone: <br />Program Element: ) (),,,5 Program Rec d: 6 6/476,,cf Inspection Type: <br />SB180 Poste4Yes No Permit Posted f•Yes No Re-Inspection on or After: <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />i;t, 44,,, & , l k ,...., w fr /, - 1 - .-. L i ‘.4.1 k Vi. L.- `,-.. ,- <br />1 04— I Aim A I i I U1 A- le 4 4D 1, 60.1 d-e___ <br />-304 JO f )chavlikivrut7A. _ 0 imukt,eA 61 aett 4,tath”, i $ AV.koik ,. <br />_ <br />or— 4r (csw_ d-o n ixittivo- ' . \A( t ot <br />, <br />o(44,1A texttir4it „old! ,t. qir <br />Item / L ocation Temperature , <br />d vtifve.4101 1-1-(Cr ,i40--- ,ANt(Lt i SK---- <br />_______ <br />Food Safety Certification Facility Hot Water Temperature 1 Warewashing <br />Name: 6 amA v.. Hand Sink: o F Iv 4 Chlorine: ppm Heat: °F <br />Exp. Date: At\ twiA RI ki y <br />— <br />Warewashing Sink: 1 e °F Quat. Amm.: ppm Other: °F <br />Received By / Title: ?S <br />EH Specialist: Phone: / 0 <br />k a <br />Time in: of 1 4 q Time Out: i h _2 Page of <br />FOOD PROGRAM OIR CONTINUATION END 16-24 (2nd pg) 4/3/13