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SAN JOAQUIN COU' <br /> Q: a <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • �4..• -a:�;;P- Telephone:(209) 468-3420 Fax:(209)464-0138 Web:www.siclov.org/ehd <br /> �r�oa <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: 'D Date: i l-/ $-/t� <br /> Address: �,(# LAJ r'Nt YYU t'- L-/1 City: Sfo C.-K-,fin Zip Code: q'52-.0 <br /> Owner/Operator: mQn mCri d.4e-r 6 re WaI Telephone: °Ia3-5 9 1-1 <br /> Program Element: �f00 Z� O( Program Record: O O d�� Inspection Type: <br /> SB180 Posted^J"Yes� No Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE AGTtONS, <br /> -- i I �cs.� _-f-ti 1e s _-- `I-1 Z.� F v-F rn�o s',�-!� ---� `� ... --- <br /> �'L a ..'?_b e rel..____1�-� G s-h_______--_ ►� 1 c_r_Q_ct✓-}-.____.____ -e.� <br /> l _ _ e �- <br /> &)cA h'lU r Ge,r+ Le <br /> C001 W i l,L <br /> Y IFc �.�I-lam i,►� 2 m u� l! - <br /> o n c-e_ •e-t- &S CA <br /> tU Y AD O v rO v rZA»'7 L Z a 3 D0 - <br /> LA.,t rn.P rlre s►�-1� 3 c�rwn 5't �L mop <br /> U -- -._. <br /> . Pr <br /> _ _ -5�►n-Com.-- 1_� YY1��G1L,u 61 Y- <br /> ltemlLocatiorr Temperature Item/Location <br /> [Temperature <br /> >7 dLA <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: S r� bCj r CAok Hand Sink: 10 t�F I 116 of Chlorine: PPM Heat: -F <br /> Exp.Date: `- �(� ar washin S• k: of Quat.Amm.: a ppm Other: aF <br /> Received By/Title: ti 1 <br /> EH Specialist:- Phone: <br /> Time in: ;2 Time Out: 10: Page of <br /> EHD 1G-24 (2^ pg) 4,3/13 FOOD PROGRAM OR CONTINUATION <br />