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SAN JOAQUIN COUK <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> - _ 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> C4.. ,. alp Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.sigov.org/ehd <br /> i <br /> Liib <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: r♦ ,T -�� )V N Date: <br /> Address: 4 t ' City: <., tDopvcn Zip Code: �0 <br /> Owner/Operator: a .`cx CCM T� 3Q_,G cd Cfielephone: <br /> � <br /> Program Element i Program Record: ( oi h G, IIinspe11ction Type: <br /> SB180 Posted Yes No Permit Posted Yes No �t U Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> . . .................. <br /> o yor&r WAM <br /> o q7, Ct iCC C\\At3\j <br /> 11 r cin e, inSo _c�l_�._N <br /> �12-� C V<(dt dkct ,e ce�i cO- . <br /> ivo yo <br /> Item/Location I.Temperature item/Location Temperature <br /> SCalc� �i Cil � (ob`'" - <br /> lz I`f :SGI cock _ <br /> 4 � <br /> Food Safety Certification Facility Hat Water Temperature Warewashing <br /> Name: Hand Sink: 'UV of Chlorine: ppm ,Heat: `F <br /> i <br /> Exp.Date: arewashing Sink: ZU of Quat.Amm.: ppm .Other. `F <br /> Received By/Titl - ! <br /> EH Specialist: Phone: <br /> O <br /> Time in: 1 I) Time Out. -� PageZof <br /> EHD 16-24 (2^d pg) 413113 FOOD PROGRAM OIR CONTINUATION <br />