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Q. °"!".CSAN JOAQUIN COUP'—Y <br /> ) ' OG <br /> Q` ENVIRONMENTAL HEALTH DEr-ARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • �4.. �;p• Telephone: (209) 468-3420 Fax:(209) 464-0138 Web:www.si-gov.orq/ehd <br /> �I FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: 61yyAV- or S Date: q pt I}, <br /> Address: 2W-}, S E; bOn St City: SW&1V_tTl Zip Code: Q'E-�) 2-OU <br /> Owner/Operator: V—X_-Un�- M . &\V17/1 Telephone: b - 'J Ao-� <br /> Program Element: ho 00 Program Rec rd: CCC3 U'�5(0 1:5)CA Inspection Type: <br /> SB180 Posted Yes No Permit Posted - Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> -T <br /> ne, Wivina nrd c111 bvzwli <br /> pri) smo s <br /> h <br /> Item/Location Temperature Item!Location 777 Temperature <br /> --— - V <br /> i 1- C <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: °F Chlorine: ppm Heat: 'F <br /> Exp.Date: Warewashing Sink: 'F Ouat.Amm.: ppm Other: 'F <br /> Received By/Title: <br /> ke <br /> EH Specialist: Phone: ,A 4 <br /> Time in: ;,y� Time Out: 3� Page I! of <br /> EHD 16-24 (21'pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />