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SAN aJOAQUIN COON' <br /> ENVIRONMENTAL HEALTH DE07�RTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax.(209) 464-0138 Web:www.siaov.org/ehd <br /> 'r CIFOP ` <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: ; ah r,' Date: lu -_ ' <br /> Address: rA-V #. // City: G Zip Code: Z I <br /> Owner/Operator: Cv_t ? 0+-LZ <br /> } 4 -t V v-4' L Telephone: <br /> Program Element: 162. Program Record: 05 3 4 -z_ Inspection Type: 1 <br /> 8180 Posted ;Yes No Permit Posted.[Yes No T Re-Inspection on or After: 1- <br /> RVATIONS AND CORRECTIV]4' :: <br /> WA - Ih ( JVt' L-,, dt, f <br /> GI2.R +0aCA _ <br /> De crew ,•,., -�-a �l °F la dq, . <br /> V ca for- 0.0oLsjctJqL(v. <br /> b(A - f1kL ciczs5 Ares &Ao,, -)a 1:-t <br /> n 4 (3u �- - O k F-- <br /> �+ _ (Tic I W k -- S ,-. F <br /> N 4a lu i b ZI '-t to ro 4-- F+,)II <br /> C7Sl� �Zci l< • Z- On -rte IGJ, 67-1 % L_AcI1 Ci'%r5E._ <br /> Owe 'A0 F <br /> Food Safety Certification '''''- • Warewashing �•--- <br /> Nano and Sink: .F hlorine: PPM Heat: 'F <br /> Exp.Date: arewashing Sink: 1,2,:) of uat.Amm.: wpm ther: 'F <br /> eceived By/Title: <br /> EH Specialist: Phone: ({6 _ �YY^ <br /> ime in: S Time Out: 2 , - Page <br /> EHD 16-24 (2n°Pg) 4/T13 FOOD PROGRAM OIR CONTINUATION <br />