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,6P9.!N 0QG SAN JOAQUIN COUI�44f <br /> sa ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax:(209)464-0138 Web:wWw s1goy.org/ehd <br /> {ride <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: ,)I (A 7 F' _ i r Date: - 1- 1 <br /> Address: City: Zip Code: <br /> 1 vt �c� P r c 9533 <br /> Owner/Operator: Sin V i . 5 Telephone: <br /> Program Element: C S Program Record: O j��S Inspection Type: T; Vrn .l <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> Cc,M V -CLII. — <br /> ri ( .I .. n$ <br /> Ile 6 r j S)e, S e)(11 Oc Sop; - 106112ary, <br /> C1 ; Glct it✓h <br /> Tr <br /> Ch (o•r;n <br /> cad; / <br /> QIr e, J r <br /> 41 V. G_ Gl � ions, <br /> 2-cc Q 14 <br /> G G i es Cf CC13 0. C'01 u(A <br /> G1t L 10 . Cl/1i �i e., eo c f1�G� '� r <br /> V­10 15 9 � Cj � I ��f� h S �ff is Gif CC le-1 <br /> Item/Location Temperature Item f Location <br /> Food Safety Certification __ Facility Hot Water Temperature I Warewashmg <br /> Name: --- Hand Sink: - _ f-- -- F (Chlorine: ppm Ilhieat: F <br /> Exp.Date: arewashing Sink: F uat.Amm.: PPm then: F <br /> Received By/Title: <br /> EH Specialist: - phone: / p-J� p <br /> Time in: Time Out: �7a A Page of 2 <br /> EHD 16-24 i2-pg) 4/3113 FOOD PROGRAM OIR CONTINUATION <br />