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�oP4 CpG SAN JOAQUIN COUI <br /> Q` ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax:(209) 464-0138 Web:www.s'gov.org/ehd <br /> �IF0 <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: �,i � Date: ?/1 11/1 <br /> Address: (11 <br /> 0 `ti{ th ` City: `lC Zip Code: CyS� <br /> Owner/Operator: J I 1 Telephone: <br /> Program Element: Program Record: Inspection Type: lc�nQ <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> A 0I' - -t tS - i S 4 i n 'KI' -h .n IW O I- 164, <br /> R ok -VI'AA( I' Vf 0►'fh►'A ! -th he- Po)lo(,jjna viW44161 <br /> r)eeA 4y be LyrreeftA. <br /> 8DIAWC&h rVAA11I11qq .� 10 Apen h1 ,' t V1 ,` ,1 Drsh <br /> It Ir Personrred- 1 to ' <br /> 5 h1 -floor HLls daftlaqed ' sol ,"I <br /> I� Lir GI G 'n <br /> 612 v n ' IK-in unrws UFO� <br /> a+ ° en� l l f S -I b ° Cerra 4- <br /> .� DOW i n 44' 1176 - 00 i'n h0f Lau 4- o 1240- F. <br /> da . <br /> Item/Location Temperature Item/Location Temperature <br /> ._.. .---. ---- --- -- --- —----- <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> _-- _...__..... <br /> ---.....– <br /> Name: Hand Sink: of Chlorine: ppm L4e�� of <br /> Exp.Date: arewashing Sink: ofQuat.Amm.: ppm : of <br /> Received By/Title: <br /> EH Specialist: . -� Phone: ¢.? 6 <br /> Time in: Time Out: o Pagof <br /> EHD 16-24 (2n'pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />