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SAN JOAQUIN COUN <br /> > �rA <br /> n .< <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> •.r<4., . .�;?• Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.sogov.org/ehd <br /> t�AdA�' <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: T;k- Date: $- 12-11 <br /> Address: r y<'l N. 4,,5vbEr city: 1,o O/ zip Code: 95-Z y Z <br /> Owner/Operator: 7-blt5 Telephone: _7333 <br /> Program Element: A0 1 Z Program Record: S3V. 35 Inspection Type: <br /> 8180 Posted 9 <br /> Yes O No Permit Posted AYes D No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> (Z `'OfitsL r f NSF (S F PP t jeu I Awn<b ri47�[ <br /> _¢ _ r <br /> Item/Location - Temperature Item/Location - Temperature Item/Location Temperature <br /> IyDt) R <br /> Food Safety Certification Facility Hot Water Temperature Warewashing _ <br /> Name: Hand Sink: 13S ,F hlorine: ppm Heat: .F <br /> Exp.Date: arewashing Sink: -F uat.Amm.: PPM Other: eF <br /> Received By/Title: <br /> EH Specialist: one: —Q( <br /> . <br /> Time in: r2• Time Out: 15 J Page.qf <br /> EHD 1624(2b pg) 112b9 FOOD PROGRAM OIR CONTINUATION <br />