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SAN JOAQUIN COUNY" <br /> �+ ENVIRONMENTAL HEALTH DEPARTMENT <br /> 11_ 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> ... _ �a• Telephone: (209)468-3420 Fax: (209)464-0138 Web:www.si_qov.org/ehd <br /> qC/FORS <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: d (jl_ Date: .412-Uf L2 <br /> ddress: 12(O L. M U f W t City: (,�t-G-N Zip Code: C1�,�J U� <br /> Owner/Operator: � a T�on f pP ` u; Gk Telephone: _lL <br /> Program Element: V26 Program-Record-- �R J C-:<() ,F(j Inspection Type: gip;n <br /> 6180 Posted ❑Yes ❑ Rermit Posted ❑Yes ❑ I Re-Inspection on or After: e,-)- C, <br /> : 4?¢SER11,4T1. ala AND CORRECTIVaACTt,ONS <br /> d) The Wzg7 w0 er kVo rO U, cLt TtL2, t rdSIn'f- S <br /> ct, Fir, a <br /> bL'va V\AC <br /> of o ie_ . rk-ttc4rn MonucVl in <br /> Me <br /> The 'qvi t r,1 RZ is c sin i .eXed , WN\ <br /> cwSiv"Z-r <br /> "Iltie'Ca Q� GA-reaV__ CM Ttxe WMa anC) .eS . WCfq <br /> 5 sure ` j c �n�-�S �- hc��.e ter;CLe <br /> �i s o, C j&)p Cke o n i n Cc/trTecA- 2 v.4 joe__,V- <br /> Item/Location Item I Location Temperature <br /> CO2 1zA(\IGS 0�_e_ noV- iruzl - t4 <br /> Food Safety Certification Facility Hot Water Temperature Warewashmg <br /> Name: Hand Sink: of Chlorine: ppm Heat: of <br /> Exp.Date: Warewashing Sink: (�G of Quat.Amm.: ppm ther: of <br /> Received By/Title: <br /> EH Specialist: Phone: <br /> me in: t I Time Out: 2:� Page hof <br /> EHD 16-24 (20"pg) 413113 FOOD PROGRAM OR CONTINUATION <br />