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SAN JOAQUIN COUP Y <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> X <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.sigov.org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: 1, ?20"�Ao Q r('1 I* Date: V <br /> Address: �Wvchr q VY City: C>tX.V_-v) Zip Code: Iry'2_o 4r <br /> Owner/Operator: cku I LQ�l Telephone: 4iO4 -6q<2) <br /> Program Element: 1 O Program Record: C000 3+43 Inspection Type; COM r)t- <br /> SB1 80 Posted Yes No Permit Posted Yes--g-No--- Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> kA('k <br /> C' <br /> v)o+ ob,,teryP_ Ckn �� ve cyT- cVad P-o(kak<, '1K'\ AA-,Z �ak <br /> r)U WIL MAS M.=- (�nqinM n Aly <br /> Aho' �m n P kus _mSfiU --I ) <br /> 6 ,-P-xN , w-cl 1„j n. yv_a vkde Ix o monlh <br /> V�k'kmckln �es+ to)-11--u- )I OPLI a C,win fac� 1 41 <br /> L W V-0 C4,101 6rte 1?i MS -)q” <br /> Item/Location Temperature Item J Location ----Temperature <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> lChlorin <br /> Name: Hand Sink: '17 Heat: 'F <br /> ppm <br /> Exp.Date: "Yarewashing Sink: 'F Chlorine: <br /> ppm Other. 'F <br /> Received By/Title: <br /> EH Specialist: Phone: <br /> 9L C'q- <br /> Time in: Time Out: Page-,of <br /> 10 - 41�_ I <br /> EHD 16-24 (2-pg) 413'13 FOOD PROGRAM OIR CONTINUATION <br />