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SAN JOAQUIN COU �( <br /> P • <br /> X ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax: (209)464-0138 Web:www.si4ov.orq/ehd <br /> �IFoa`' <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: A r Date: 3-5 --16 <br /> Address: Q U V Qom,{ V <br /> City: C-�V C-9 Zip Code: IS 20 <br /> Owner/Operator: V? /17 C4 r ,/ Telephone: af45r/ 7�8 <br /> sf <br /> Program Element: / Program Record: Q n O J D 9 D Inspection Type: u1/J *t-.e— <br /> 6180 Posted Yes ❑ Permit Posted 'C Yes ❑ 1 Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> � aLo o►- n de !.r' U/ ' r o CQ o21st c e Zt.�✓e�I <br /> 1:;�,n r v✓-e.c+ L_- <br /> ro•e d ••-r n o•� La.-b-e L.� d /-�--L�.e�P � <br /> 4- v ,e <br /> ne h H sem. <br /> e n-L' -tv w <br /> _k- A)5-o P1041 -�n u c-t <br /> _ Esc, ��rli-out- S�r� u � F o►- lraw� r <br /> _'Pro c.q_ N 1/0 of -7 r Dam' 3 7 <br /> Item/vocation Temperature <br /> 1 t � <br /> y „C-1�,!1,{�_0_ _�oc.i •-) r 15 WCt►'►r►.e r --- I'b 8,F <br /> I �5�F U-)CkA, A <br /> op Gvo ✓ /°- <br /> Name:yyt i�e Q I�no vi �r^V Hand Sink: J�0 o fChlorine: ppm Heat: -F <br /> Exp.Date: a rewashing Sink:/-I, D of uat.Afnm.: ppm Other: °F <br /> 1 I�OZVIA <br /> Received <br /> EH Specialist: / �•J Phone: q63 �n <br /> ime in: C• Time Out: r 1 �5 Page of f j3 <br /> EHD 16-24 (2° pg) 4/3/13 { FOOD PROGRAM OIR CONTINUATION <br />