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a <br /> SAN JOAQUIN COUNTY <br /> .eaG <br /> . 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 /> �iFORa <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: QTV112f,_. (in (• Date: 1 G <br /> Address: -6,5br�t Si- City: rl-„ -t-�( Zip Code: --7n <br /> Owner/Operator: , cU n �C4 �rl Telephone: "I <br /> Program Element: ( 7j?_ Program Record: �y G C--'1NCi -151M Inspection Type: <br /> SB180 Posted ❑Yes ❑ Rermit Posted 1 c Yes ❑ I Re-Inspection on or After: 1cckt <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> FFVi as o t 10Uf a., sOvn cxSSIbl e _ <br /> ?- �e r mord i a fi N=. 6 �z cA Ivw <br /> 3 (viG G Njt �A- I Z1_. <br /> CA 1 C)LT , <br /> Item/Location ��Temper to u e Item!Location Temperature <br /> — - )-d r Ken l..... _ ..--------- __ ._..._ti f _ <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: 1C;J �I,1 .-il .z” HandSmk: of Chlorine. ppm Heat: �F <br /> Exp.Date: _ (� arewashing Sink: of Quat.Amm.: m Other: of <br /> Received By/T tle: <br /> EH Specialist: Phone: e7 ow — <br /> ime in: O ;y2 Time Out: f-vtw; �I Page-hof <br /> EHD 16-24 (2^ pg) 413113 FOOD PROGRAM OIR CONTINUATION <br />