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�o.P4�.coG SAN JOAQUIN COUP" <br /> ENVIRONMENTAL HEALTH DE:,ARTMENT <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 /> qc;FORa <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: �q (��S G() M G�t Date: 1/18/ 14- <br /> Address: <br /> /814- <br /> Address: q01 C . V� P=00 City: S+-toc*--Von Zip Code: g52o(0 <br /> Owner/Operator: e r h Ciro <br /> Telephone: c�?I _ 06 <br /> Program Element: ME, Program Record: p 61� I ZZQ Inspection Type: Fmo'n:� �(3R <br /> S8180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: I <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> Wl'_, 101a-h Corr X <br /> f (Q S(Qo waS S:tM tt,S�C� iCQ, i`f\0.0 :In.Q - CcXre 't=1 c)T\ atie <br /> No .�r' �w� S fi han vuas siutia� . i� <br /> llb"T- . lRaast- -r6 \20`f CX_ ; -ivda <br /> be Q Fo WtDa S -%k f CCt4e -;r C, S- fox <br /> ur 11 d C 46 t4-v wi -FRIG\Oq CII e t\cA Wress <br /> Item/Location Temperature Item/Location Temperature <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> ......- - -- ........_.. —_.__.... -- - ----— —_ — ----- -- - -.-....------- —--- <br /> Nam- e: Hand Sink: of Chlorine: ppm Heat: of <br /> Exp.Date: Warewashing Sink: of Ouat.Amm.: ppm Other: of <br /> Received By/Title: -- — - <br /> EH Specialist: Phone: L)M 46 <br /> Time in: (q Time Out: kc) -. LID �U Pai of <br /> EHD 16-24 (2a°pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />