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ObSelzved vencl&12-- Mir k FeacLi eafr F-coct: <br />Pi ,V.untimLe too a‘e ofilvi crceAl oeO012_ <br />‘FaFCA (A- Ctr oc cd corn ifi CAcIJ <br />Lci cDmniu,r0 CA 1 (um ary <br />rld Oct i4rArd <br />Other: Exp. Date: <br />°F <br />°F <br />Chlorine: <br />Warewashing <br />PPm Heat: <br />Facility Hot Water Terri <br />Hand Sink: <br />ature <br />°F <br />Quat. Amm.: Warewashing Sink: PPm <br />Temperature <br />Name: <br />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.siciov.orq/ehd <br /> <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />Name of Facility: <br />Vallfirt05 ‘-'F'{iati ' H 0 it'"(1* 4 <br />Address: <br />6_401,,(- Date: <br />11 I 17 ion ?"qe ?-ck City: ZipC Code: Z S- Ok, <br />Owner/Operator: .9(,t ce 1,-; WI rh Ile>) Telephone: 61 4 405,c <br />Program Element: I 1,0?)k, •Program Record: piz 0 c „..,._, za6.--- Inspection Type: <br />SB180 Posted rl Yes 0 Rermit Posted C Yes 0 I Re-Inspection on or After: <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />Received By / Title: <br />EH Specialist: <br />Time in: 1k 4() <br />t_eo\(4 <br />Phone: <br />Time Out: <br />-4C0G <br /> <br />Page of I <br />END 16-24 (2nd pg) 4/3113 FOOD PROGRAM OIR CONTINUATION