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SAN JOAQUIN COUN1 <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 /> �IFOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: a Av -el/lt,, n c Date: S I <br /> Ils- <br /> Address: ? .� 9 City: Zip Code: <br /> a� <br /> Owner/Operator: j CAfi--7,y , f�­ Telephone: ; �1 —0l„ 11.E <br /> Program Element:/ � 'Program Record: / 3 ' Cf 4P Inspection Type: A amu/— V� 1 1f' <br /> 6180 Posted [ es ❑ Rermit Posted V Y/es_1❑I Re-Inspection on or After:'vV <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> b <br /> IU-A &k '✓l/J�` ✓L r C f �? ` j ! t <br /> u� <br /> via <br /> k <br /> &A/" <br /> , (VV, T (xkr dov nom(0 <br /> Item/Location TerrIpgrature v Item t Location Temperature <br /> VrIeKI <br /> 110001✓u av"t--w� F <br /> r4v "4 M d4 It P I A <br /> Food Safety Certification Facility Temperature Warewashincd <br /> Name: C Hand Sink: pp_ <br /> " wl o f Chlorine: m Heat: OF <br /> Exp.Date: -j-- arewashing Sink. j of Quat.Amm.: ppm Other: of <br /> Received By/Title: <br /> EH Specialist: _ p Phone: <br /> Time in: / " `) rV w Time Out: I� O Page'Zof Z <br /> EHD 16-24 (2n1 pg) 413111.3 FOOD PROGRAM OIR CONTINUATION <br />