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PQ��" SAN JOAOUIN COU40 <br /> �O.�.CpG <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.or /q ehd <br /> ��FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: 5 � Date: <br /> Address: 1 3 �� /L ,� City: ,71D C'X� Zip Code: <br /> Owner/Operator: CA-4•C4 b4o'q n (.c_ Telephone: l- (10 Y/'J <br /> Program Element: Program Record: 1? 0�� �Z Inspection Type: 1-4C'C_'?47 <br /> SB180 Posted Yes No Permit Posted (Yes No Re-Inspection on or After: 3-30-6' <br /> OBSERI/AT{©NS AND CO RRECTIVE,ACTIONS_ ...; <br /> e,f % __ n o +�__k o+ -e n f�h ci-)- ) ,:56"'f- Ma.n f- <br /> 6) <br /> 6) 1 rrt.e►' _. W as no+.__ oPIN - -Por -- coo Ke_ V e_f)n_i es L) <br /> `l.._Y> ► _.._-T�►=--� -h r� U�c. 4- m-e S aL i,i e, h 1._t L'f-/-z n <br /> >aKT yj C�,+ BVI Goo Ke ofy-ea� i-ls e4»d _uv+_de._r -Gzn� <br /> --K Con met- fi-o f •` ` ._ Le A•7 of v� a n <br /> 4 Y7.5'1 I W 1-t a 1Ze 4 Y'ac-_Y) <br /> Yr. v Lo `e- Wa5 r i riJ e -'!T 5�i ex,� 4 i b0 r'l e-4-- <br /> r o L60d5 . <br /> Gj J Lu_ h-7,n Ice r h u S 1 o-ts o mo Gd . h-a tt ka.e_ Lt_,,A n-e d <br /> V pl _ _ -. C Le A rn.Ld - d "Y-1' n 5 ._. -V i's _+-- --- - <br /> b Poo A b Lyi5 n o + to,b-e-/-e- d . 5eoa 5 <br /> _._._.. �h- - -�'v_da Q5 h _ ... ._ _o -- - °f- e Y� - <br /> Qvt i-h-ze r r w,e�s i, .e Ac,K h oL LC ta-e- o ..m................ <br /> Ior,r't+tie. v(`,-4- au num ......... _rP...£.`�._d......�_......... <br /> _ <br /> X r t 0 r o-IP h-1 i C'/rb VjQ v'-e i,5 r-ea <br /> i u.t_ L GLe <br /> �I oo r -H Les vie. d o ro b ,�►,on+ti <br /> �,r -- --------- Cq r d . ro v-1 j& J 0 ..ax_Ks ' <br /> ' lterriJLoCatiotil Tem nature .item f Locatlo Temperature <br /> , <br /> 1�� <br /> Ce I Li0 r <br /> FacitlSaf� G rt�fCsfion �4_ -acii�tyNptWaterTem nature_ a v Yffafewashing <br /> Name: Q /s h atA Hand Sink: oFW Chlorine: PPM^ Heat: 'F <br /> 1.Exp.Date: _ arew hing Sink: s� of Quat.Amm.: ppM Other: of <br /> Received By/Title: .� �Go <br /> EH Specialist: "' Phone: <br /> ave ��-t _4)�3-_'�8 i7 <br /> Time in: J ;. Time Out: Pageof <br /> EHD 16-24 (2n1 pg) 4/3113 FOOD PROGRAM OIR CONTINUATION <br />