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SAN JOAQUIN COUP <br /> X 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: QU I 5 LQ m Date: / i _) v <br /> Address: > 1 a Li Q CA, R c' City: 5-1-0c4e-to n Zip Code: q 5;V.7 <br /> Owner/Operator: 6 U Y" 'OL 11 <br /> 1 ►, 5 D ✓� T, Te ephone: <br /> 'l NZ3`�-4 5 5 '� <br /> Program Element: 1 /_2� Program Record: to I O t to-0 <br /> -7 Inspection Type:Zn oi na <br /> B180 Posted f(O ❑Yes ❑ Rermit Posted n~ ❑Yes ❑1 Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> 0%ru of 1h A n 8s k f\� a r-e n .-k } ct cam►-, <br /> o-- -k ty r - l or s U-Ot r d ` rn v <br /> Y w� t - <br /> 01.Jau(-0,6 <br /> r�` ����_Q Y ��•`��CS1rl-`� IJLJ_J�JI.`�'./Y� y '�` G � —.. <br /> o-1-p-Y - co Y <br /> Item/Location Temperature Item/Location Temperature <br /> i <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: . _ �IHand Sink: 'F 'Chlorine: ppm Heat. F,_ <br /> Exp.Date: Warewashing Sink: of uat.Amm.: ppm Other: 'F <br /> Received By/Title: <br /> EH Specialist: -1 _ nPhone: L <br /> Time in: f `;2G, Time Out: Page 1 of <br /> EHD 1624 (2-7) 413/13 FOOD PROGRAM OIR CONTINUATION <br />