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SAN JOAQUIN COUP' <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.segov.org/ehd <br /> �IFORt� <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: 1�YA' , S M >I Wt Iy L Date: I-} <br /> Address: A1025 N tuncan City: 1" Zip Code: 5 23( <br /> Owner/Operator: v10-0n t• TU Telephone: &r 1�� V <br /> Program Element: 1 I1�/�1- Program Record: -�t 0 1� ( A lb Inspection Type: (MJ6 n <br /> SB180 Posted Yes 1 No Permit Posted Yes) No 1 Re-Inspection on or After: ``-C <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> c ecArz -S#Xed . �taz <br /> Gut d eIr -bdCkv , cufftcAM <br /> cu '-i )I35` and 'woYed CbicXen <br /> njr �ZCGM S rT 019- VW`- r dia <br /> 3 -ed S ,2Am -ed cmt1V_) S S1meca -t- <br /> 1-" I-WeS hUje e- 1 r S IM4e trLe <br /> srnmer afire �n� Id alae UNZ i -irZ <br /> S .Ves, W(AT) 0s &Wn Ias c"Ll ge <br /> � tat 0111 FOCCACAW, CCN"j -nSi ccx)L &• cwt o <br /> S Gv 50 a+ 166 PDA <br /> ale <br /> k- o * l S at -13sw -Mw1>t -to lmw <br /> VF(N -& 1 1 5 i 'L Qe*. <br /> SC"S UVe ImA& f 2 <br /> Maio (:�Aff_e �. <br /> Item/Location Temperature item/Location Temperature <br /> r <br /> CA ' Coir - - - - Plb (J(IE cg\ smrn W�1a- 16-1 �E_ <br /> dr coabel" 3 c\(- <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: <br /> 1��,`S Hand Sink: I CC, of Chlorine: ppm Heat: of <br /> Exp. Date: ( / arew hing Sink: i-� �, Quat.Amm.: , . Other: <br /> of s( L ppm of <br /> Received By/Title: <br /> EH Specialist- Phone: Ac( _ 2 /t <br /> Time in: C i � Time Out: i o: S O _J Pag62of <br /> EHD 16-24 (2n°pg) 4/3/13 l FOOD PROGRAM OIR CONTINUATION <br />