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SAN JOAQUIN COUP <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 /> ��FORN <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: 'Cl/ --� Date: 1'2--Vi_ 1 <br /> Address: I I-1 CIC t> City:—( <br /> Zip Code: q S �-b <br /> Owner/Operator: , {. b j Telephone: 1-4 52-3 <br /> Program Element: t 1_1 5 Program Record: `b IW2,,4 y Inspection Type: <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> Y_L. <br /> Cz�-� - tit\ to Sw: <br /> Item/Location Temperature Item/Location Temperature <br /> �- - 38 <br /> �1 - u I = Z —r 'l OI= <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> .__�._�..... - --- -..---- - - <br /> Name: Hand Sink: of Chlorine: ppm [Heat: ofExp.Date: rewashing Sink: ofQuat. Amm.: ppmther: of <br /> 1 <br /> Received By/Title: <br /> EH Specialist: - Phone: 1-4 V? o3lo <br /> Time in: kc; 0S Time Out: . IOC PageZof7 <br /> EHD 16-24 (2nd pg) 4/3/13 FUJD PROGRAM OIR CONTINUATION <br />