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SAN JOAQUIN COU. 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.orq/ehd <br /> �iFOR� <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: l C S Date: y } <br /> Address: fir► S City: /,L Zip Code: <br /> Owner/Operator: /r/ r Telephone: yy q, 3 GG <br /> )1 <br /> Program Element: b oc Program Record: CO ©0 7 8'3 9S' Inspection Type: <br /> SB180 Posted Yes No Permit Posted Yes No / Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> C. 1 -y, S 4u 4e.5 , 16 !o SK. 4 is s ue o,-, S Qm 1w, r <br /> { r� /c e wha o* <br /> cd wi-c the gi nc✓ <br /> 5'•�e :S:�' ' 1V was 61 W 0 ri 0 C . <br /> All in loyeei bts �n lov / �� off' ec�llor>t <br /> SC r,r.4 an +Vo 11 S4 1) 6 re n ' { c1 <br /> CNa i5 4o OC64a4es �l. e <br /> GU me,slion 7, O Ndr Qnd n 0.0 to <br /> Item/Location Temperature Item 1 Location Temperature <br /> - — <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: of Chlorine: ppm Heat: of <br /> Exp. Date: Warewashing Sink: of Ouat.Amm.: ppm Other: of <br /> Received By/Title: <br /> EH Specialist: CV Phone: <br /> Time in: �(f:1 Time Out: 0• ys Page o$ <br /> EHD 16-24 (2°1 pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />