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SAN JOAQUIN COU. <br /> aEr� '•OG <br /> 2� ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax: (209)464-0138 Web:www.s'gov.org/ehd <br /> C f F O'Rt� <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: � Date: <br /> Address: 1/�4 G /1, City: / v�, V tw Zip Code: O <br /> Owner/Operator: c7TV vT� Telephone:4062_C1Program Element: 1 ogram Record: Q PC)C+ ( 3 f Inspection Type: <br /> (000 <br /> 6180 Posted 1 ❑Yes ❑ Rermit Posted �rJv❑Yes ❑ I Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> U1 is W ..f, ► - lacted 601 Y-L . `-I-i m r Lia,-3 <br /> r� <br /> 6e+ JjQ fir h vv Cr �_ , - s <br /> o LaL ` art, A. nye <br /> �- 1 door e--e eoo Le r Z,� •-brzD -p n n b c�,e-r <br /> V /Vv� o d 5 YL.L <br /> 1 C.o Lo_ r <br /> V1-'1 OL r o a 13, a O r Lwer <br /> r �� n its -40,0 C8, n <br /> -h me s <br /> 0-1 nze <br /> we IIse Y1 O 1- r i--o ci- <br /> ail pera6 f Temperature <br /> ............ <br /> Food Safety Certification Facility Hot Water Temperature ! VYarewashing <br /> Name: Hand Sink: of Chlorine: ppm (Heat: of <br /> Exp.Date: arewashing Sink: 'F Quat.Am <br /> ppm Other: 'F <br /> Received By/Title: 'Z- <br /> EH Specialist: ( <br /> � p O WJ( _„iifi_-� Phone: 3_ 92 y <br /> Time in: Time Out: <br /> Pagyf- <br /> EHD 16-24 (2n'pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />