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o?Q SAN JOAQUIN COUt <br /> ,yam ENVIRONMENTAL HEALTH DFr—ARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.sagov.org/ehd <br /> L/FORS' <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: l *1kW, Date: Zs- ') <br /> Address: WU 4 <br /> -t r►I a City: 50 c Zip Code: /1]!)wZ <br /> Owner/Operator: MA y u Vic.{ I u0n6\-t <br /> �a� 6\4(A P Telephone: /, 2 2 <br /> Program Element: ' U i /- Program Record: �j 6 1 foo b 4 } Inspection Type:2`-T <br /> SB180 Posted r Yes No �O Permit Posted -]Yes 1 No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> cueI - — - <br /> Item/Location Temperature Item/Location Temperature <br /> Food Safety Certification Facility Hot Water TemperatureWarewashing <br /> Name: 1�1ICIh Hand Sink: of Chlorine: q,, Hat: of <br /> Exp.Date: ��� ; arewashing Sink: `F Ouat. Amm.: her: of <br /> J <br /> Received By/Title: G <br /> EH Specialist: Phone: �. _ (pC6,_2 d 6 <br /> Time in: i Time Out: J 1 Page of <br /> EHD 16-24 (2nd pg) 4/3/13 FOOD PROGRAM DIP CONTINUATION <br />