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SAN JOAQUIN COUP, <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.sogov.org/ehd <br /> 4rrdk�' <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: 1 rel&S Date: .1130/14 <br /> address: 5U �l . b`1r1� UT \oa city: S G)cton Zip Code: JwS <br /> Owner/Operator: 1 Q Y Q kL Ran �t M0�tn�l� Telephone: _G��,r�l <br /> Program Element: ' bZ Program Record: G\(p 1 '�- '-'V Inspection Type: fle <br /> 8180 Poste Yes ) No Permit Posted Q <br /> Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> NO SUn i ' S{zrr•' w� T� G s . ROv i(9� a . <br /> 2 CO-a. ' Uy*S arra nod dm cttdln -lIado1 . <br /> oue Foci rS csh Sh�iv� an G\ CUv.2 _ cll�an <br /> vetwxv� door' <br /> cju <br /> 5 lot let not ns\de 'tea. Cay . C&T�ecA- ted <br /> ICW o d MAOW `S SQf c (A+e i n <br /> 2)U <br /> gill Vdr\\ Mover to 9\C0 jl�zo mcm-lr L .e f Sv(r6 to 5n <br /> 0-mo CMS <br /> v&Y-i us w\5vcAun c o-* cAN <br /> ttrat�dl e r cdc m s i <br /> _ Item/Location Temperature Item/Location Temperature <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: . ()O ,F Chlorine: �,frA,\ PPM eat: of <br /> Exp.Date: arewashing Sink: I eF Oust.Amm.: PPM r <br /> ther: of <br /> Received By/Title: <br /> EH Specialist: Phone: <br /> Time in: t •.U() U Time Out: t Pagdjof`Z <br /> EHD 16-24(2d pg) 4/3n3 FOOD PROGRAM OIR CONTINUATION <br />