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SAN JOAQUIN COUP' <br /> y Z� ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax: (209)464-0138 Web:www.sigov.org/ehd <br /> LiFORa <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: ',� L' (M �� +t�, (� Date: <br /> Address: 30 �/ C) City: S1 vc i(.��,� Zip Code: S� <br /> Owner/Operator: �f�e i l C-)Cw : Telephone: l�r-� <br /> Program Element: i � Jl Program Record: C�7" � Inspection Type: Ply�'�P�f ' n <br /> 8180 Posted 1 es ❑ Permit Posted es ❑I Re-Inspection on or After:�}� 1 <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> 7V 171- <br /> a &cw oct. puSS (a <br /> -ftlllir c r i n rain . <br /> 1 . i CSI S 11�0_, . j _(CA <br /> S <br /> V� d !P_9S ;mc; - <br /> W 1 k In w i C71k1Z or <br /> CJS ; cin 1� n <br /> C) b j SCull-►i n u e f� ala <br /> M, l.mj i��rs # - a <br /> / n -I�� 'r n.F,cs Grp n0 JU ' - � <br /> (F) S d �fi is C�+ 1 - .camtr- <br /> ot <br /> r G ;?CL n` ��GIz� _ - tit+ (Au4- CM - <br /> `` ftem/L ovation Temperature Item/location <br /> Temperature Tem erature <br /> �.,may_._ _.._._ _..._��._— _______--,- , <br /> _ <br /> CAW M (cry i 'a rl r C ( A:'j °r <br /> IWO �_I11WA +tA 1410 <br /> oCk <br /> ------ <br /> Food Safety CertificationFacility Hot Water Temperature Warewashing <br /> 'I <br /> Name: Hand Sink: t (.)G of Chlorine: flVC,I ppm Heat: -F <br /> Exp.Date: arewashing Sink: (2U of Gluat.Amm.: ppm Other: °F <br /> Received By/Title; <br /> H Specialist: Phone: <br /> Time in: : Time Out: U: Page f <br /> EHD 16-24 (21,pg) 4/3/`13' FOOD PROGRAM OR CONTINUATION <br />