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SAN JOAQUIN COUP✓ . f <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> _ = 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> �4.: •.�;;P Telephone: (209) 468-3420 Fax: (209)464-0138 Web:vvww.sigov.org/ehd <br /> ��FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: <br /> Address: n q mom' City: .�� Zip Code: <br /> Owner/Operator: V t/ L Hyl --, Telephone: 10 <br /> Program Element: 1, 1 Program Record: /' /Z- p 5 �&0 y7 Inspection Type: ZONA tt <br /> 6180 Posted es ❑ Rermit Posted Yes ❑ I Re-Inspection on or After: 1 M 6Yx+)1 <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> U '-: Y uY�c�M YtiC, , L >7 d h • YYL�vn,�c�-i�� Cl t Ll j'-j- <br /> w- LO YYLOY`C G (-C 4D <br /> i /CO Y Y?_C 4f <br /> Moo 1 D � —S V'J CN\-Av"J OVA 1r W O U Yl 4l <br /> m® Lo-01 ns'_ bC-t, q- Y1or a bzscw 1� n4- <br /> -F) <br /> ) r e,5rtts 4-. Ue or n U n of <br /> %+ <br /> cAD Y1 tN•P <br /> - <br /> Item/Location Temperature Item 1 Location Temperature <br /> H)a_oh o CAee-' 1'136 s <br /> It 17-1 CAvni �s Irjcl <br /> 2 ac;o,r d•e l _11 r 1)c1 M- o vj q Y r ---- ►�2°F <br /> Food Safety Certification Facility Hot Water Temperature Warewashng <br /> -- ._.__...�:..__...:_ z, <br /> Name: Hand Sink: of Chlorine: ppm (Heat: of <br /> Exp.Date: w h�inn ink: of uat. mm.: ppm Other. F <br /> Received By/Title: <br /> j <br /> EH Specialist: ^ Phone: <br /> Time in: Time Out: D PageZf L <br /> EHD 16-24 (2ntl pg) 413113 FOOD PROGRAM OR CONTINUATION <br />