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SAN JOAQUIN COUP' <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> ...... P Telephone:(209) 468-3420 Fax:(209)464-0138 Web:www.sigov.org/ehd <br /> i 6W <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: I 1F01(_�_i(j I; n('N Date: <br /> Address: (_tl 3- Cit _ ,- y' Azx) Zip Code: <br /> Owner/Operator: 'LQ (`, )(AVCAq Telephone: <br /> Program Element: Program RecorcV Inspection Type: <br /> SB180 Posted ,Yes) No Permit Posted Yes No Re-inspection on or After: VVI V <br /> OBSERVATIC3htS AND CORRECTIVE ACTIONS <br /> w1 M C, <br /> ............................ <br /> CV0 n <br /> ........... ....... <br /> vqc-k�bk_f DALTC Oer �otrl C)M <br /> 1 W (_Ind P0 V,?/r Q <br /> 'Is 0�_�U. V-e <br /> Si In� <br /> ( \1�h h2e(� �7,ek&re -tCC-A V��P) C'(fAAAV C, T)Qt(Aa �Q <br /> "�-CA ,I <br /> ....................................­_­............ ................. ..................................-..................... <br /> -A <br /> IV) <br /> &5 CN A <br /> Cit �OUCIIF . <br /> r. <br /> Y4 2SQ, CA WC�-' HVY,,( CCj_C'LaT- <br /> -�' <br /> Itern/Location <br /> ............. LTrmPerature' <br /> r <br /> _j <br /> ................. <br /> Food Safety Certification I Facility Hot Water Temperature Wai6washing <br /> Name: and n 'F Chlorine. ppm Heat: 'F <br /> Exp.Date: arewashing Sink: �F Quat.Amm.: Other: 'F <br /> t <br /> Received By/Ti ---) �I ' T k P:P1. <br /> \ <br /> EH Specialist,, Phone: <br /> Time in: Time Out: Pagopf,-I <br /> r <br /> EHD 16-24 12nd pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />