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s <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> -- 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> �R•. �;;p Telephone:(209) 468-3420 Fax: (209)464•-0138 Web:www.si4ov.orgfehd <br /> {ii ou <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: ( ,IFUC_ Date: VOW, (�0' <br /> Address: Woct Cjh City: ��-��� CCDM Zip Code: gC51 1 <br /> Owner/Operator: y. o'44 -A 0� ?,�A u e Telephone: 2� 11 C) <br /> Program Element: �U o-) Program Record: Co O O A ` q � 0 Inspection Type:C C ICt, <br /> B180 Posted ❑Yes ❑ Rermit Posted ❑Yes ❑1 Re-Inspection on or After. _ <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> (:('V 1ct(nA- , ; SPnv+i C26+ ivRI`'YI0 6o , <br /> &\o nC3 �zo< . MAI w_- �n Cnd t o r W led <br /> 10icl t4c,}- See CI s o Wcitll-, &-T .0 i deo S <br /> V0 --t er Qi1 U 4e Ur d_PfiS SVA 12- U1� <br /> _- Oita nc1G .e V-,ocle" <br /> t Aan0 S17a'r 'V(A[ l t i 5 &X/ry k d 0V-y- [mCQ- <br /> G VA C`y"" <br /> 17iS C(r6j- Clt)\�_ ST?a, [k&l i_cl <br /> 4- V4Gtint lit-) <br /> item/Location Temperature Item f Location Temperature <br /> jL <br /> _. ,. . <br /> Food Safety Certification aciiity Hot Water Temperature Warewashing <br /> Name: Hand Sink: of Chlorine: Ppm Heat: of <br /> Exp.Date: Warewashing Sink: of �Quat.Amm.: ppm Other: of <br /> n <br /> Received By 1uz <br /> --- aC _ 4- <br /> EH Specialist: — Phone: <br /> Time in: o - i Time Out: ``I _2� Page'of <br /> EHD 16-24 (2' pg) 4!3113 " FOOD PROGRAM OIR CONTINJATICN <br />