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SAN JOAQUIN COUS <br /> q ENVIRONMENTAL HEALTH DEPARTMENT <br /> F 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web:www.sigov.org/ehd <br /> tikC"a� <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: I R-T-) Q � pe2 4 Date: 20 (S <br /> Address: `-30 S • CG d tfZX r) ICA City: 6tnc `c 1 ' Zip Code: G GJ2 o 3 <br /> Owner/Operator: t�lU •Ina. ^ u r) vt `v, ' Telephone: 60G,,5 <br /> Program Element: 1(1000 t Program Record: co 0(i Q Inspection Type: 1GI I n <br /> 8180 Posted `o ❑Yes ❑ Rermit Posted V oyes ❑1 Re-Inspection on or After: _— <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> cw lql In SfiG412s = d cr i S cr)0:mq Food an o qtzicU�e <br /> O q e ani ?ir f Ri ovt S o� <br /> tkNZ O�Nrie,r S u�- --I coo <br /> G a zr�OS h �I s <br /> CA <br /> r nS e WCt W I <br /> ItemfLocation Temperature Item I Location - Temperature <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: and Sink: -F hlorine: ppmHeat: -F <br /> Exp.Date: t lWarewashing Sink: "F F <br /> uat.Amm.: ppm they: "F <br /> Received By I Title: / <br /> EH Specialist: Phone: TIM <br /> �f <br /> Time Out: `. 1 O Page of <br /> EHD 1624(2' pg) 413113 FOOD PROGRAM,OIR CONTINUATION <br />