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C, SAN.S.'AN JOAQUIN COON <br /> X <br /> ENVIRONMENTAL HEALTH DE4' J'ARTMENT <br /> • 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax:(209) 464-0138 Web:www.sl-ov.org/ehd <br /> 4:jj R <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: -Ca1'n U4-,l U �` C-��) Date: 12-(d/ I <br /> Address: �0 -+ S, FG.t vCWQdQ City: ls.��r Zip Code: Fj*)� <br /> Owner/Operator: rj ad rl 11 i ,•�1 n ue �( Telephone: �s-_}n—6 <br /> Program Element: f ( rogram Record:Lo RCOXJ��t r ' 'r Inspection Type: <br /> SB180 Posted Yes n No Permit Posted Yes No w 1V Re-Inspection on or After: S <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> T t .1b N w i ny v k 0aticrs &—w\ \Need vb be carr <br /> i V-1VOr QMV reeds Vb 17Q 61Qan9_d . <br /> h�Ll-Zn is Ai- 1150T_ u + °F OT h'i R'r <br /> 9"XN9, CAM e "jyrW AwV aAn � m u , <br /> �,io wn i r ouch- *) i - � <br /> 1 -N <br /> Item/Location Temperature Item/Location Temperature <br /> U aswci Chi n <br /> Food Safety Certification Facility Hot Water TemperatureL—An, <br /> Warewashing <br /> Name: Hand Sink: of ppm Heat: of <br /> Exp.Date: War�washi Sin 1 7 °F ppm Other: 'F <br /> Received By/Title: _ L <br /> EH Specialist: Phone: 9tA oc) _3 . /': <br /> Time in: Time Out:ff'��1`"'�� 17TJ �+ Page I of <br /> EHD 16-24 (2nd pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />