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ow"`'"..C' SAN .JOAOUIN COU ' <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.org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: A,, Qna /,e v V-11Date: _ -12 - <br /> I <br /> Address: , 2b o City: Zip Code: �5-2 0 2 <br /> Owner/Operator: cn 9/'h-et r5 Telephone: <br /> J`7 0 �2� � !O qS` 96 7 <br /> Program Element: /& Program Record: P/3 <br /> a��6 Inspection Type: <br /> , <br /> S8180 Posted a� Yes No Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> (D Oxr n 13 61Yf Vlio4- ha4 ..vnax-e h . 06L44 +P_r, •W4-en h oa_L�.�-� <br /> KAIxt,,-A� -(oo 8s a+ 135'f o r �;C� r <br /> y 0 rn coo r Ls no 4- 6t If - Cos'n +n'Cc ckv-i c.'- b <br /> 'kn -Fr�.e le r <br /> u .} o� h ecL l �c r�•-�-� ts <br /> 'gyp �ut�tik <br /> 0+i--t ,r via L4,4i 6T'-_S w.n.�4k n `1- - <br /> Item/Location I Temperature Item!Location Temperature <br /> rr► !-30-135`F <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: of Chlorine: ppm Heat: °F <br /> Exp. Date: Wa shing Sink: at.Amm.: Other: <br /> C i aC1�F o 1 Lel PPm °F <br /> Received By/Title: <br /> Old <br /> EH Specialist: Phone: 01:53- 221') <br /> Time in: O Time Out: Q Page( of / <br /> EHD 16-24 (2n1 pg) 4/3/13 \l FOOD PROGRAM OIR CONTINUATION <br />