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0 P SAN JOAQUIN COUNTY <br /> , c <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • oq., �;P• Telephone: (209) 468-3420 Fax: (209)464-0138 Web:www.s6gov.org/ehd <br /> ��FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: V n A V (4 I e 4 P►i u e".. a Date: <br /> Address: -72o <br /> W g a' 54. City. Sax Zip Code: CI 672 A(, <br /> Owner/Operator: (4/ � r C G Jo Telephone: <br /> Program Element: 6 U I Program Record:/ 5 Q c,0 <br /> G `5� Inspection Tye <br /> SB180 Posted 71 Yes ❑ No Permit Posted -_Yes n No 17 Re-inspection on or A er: r <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> de r, I wo Ier U a' 0 <br /> I. Tv Pry a <br /> y Gvi di Ic <br /> di <br /> h <i `( C /1 ); h � � P <br /> S iv v i a G� / t 9 <br /> IGV ; de or <br /> r v v : rl S a s a� I! <br /> g rinr c : nK <br /> 9 f a O PIt,; h WoGd Cenrrrnll <br /> G h <br /> �G .SPti G an� �' vIPt S <br /> 1 3 - C S ; IC of, U n dn, <br /> rd <br /> 0v; d mcira Cer I : �� cc, !e ih 6 C <br /> U 5 G c(nr i h wtPlcs <br /> Item/Location Temperature Item/Location Temperature Item 1 Location Temperature <br /> Food Safety Certification Facility 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 /> Received By/Title: <br /> EH Specialist: Phone: Y6 P • 316 B <br /> Time in: Time Out: Page of / <br /> EHD 16-24(2n1 pg) 4/9/12 FOOD PROGRAM OIR CONTINUATION <br />