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SAN JOAQUIN COUNTY
<br />ENVIRONMENTAL HEALTH DEPARTMENT
<br />1868 East Hazelton Avenue, Stockton, CA 95205-6232
<br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sigov.orgiehd
<br />
<br />
<br />FOOD PROGRAM OFFICIAL INSPECTION REPORT
<br />Name of Facility: -- , c e_
<br />Date: -- 1 •2.. 3 / 2._ y 4.,,
<br />‘ Address: Iv 14. Ai T4:1 LA, 0 0 e it? j City: /
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<br />Zip Code: 41 5_ 3 ‘ Z
<br />Owner/Operator: 7- Se} ii`e-ehli-jir LLZ
<br />r Telephone:
<br />a. Program Element: (-71,7s.. •Wrogram Record: PR 2Lf OD 2-7-g inspection Type:
<br />SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After:
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<br />OBSERVATIONS AND CORRECTIVE ACTIONS
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<br />Item/Location Temperature
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<br />Food Safety Certification Facility Hot Water Temperature WarewaStillillia
<br />t Name:Heat: Hand Sink: 1 G -• .F Chlorine: ppm °F
<br />Exp. Date: Warewashing Sink: 1 7 , 0 Quat. Amm.: ppm Other: °F
<br />Received By / Title: IA r, d h i /5w-e IzArnile---7
<br />- EH Specialist: Phone: _.. 30 se--.2_
<br />t- Time Out: Page of rp ime in:
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<br />END 16-24 (2'd pg) 4/3/13
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