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.C'\ SAN JOAQUIN COUP ' <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> �Q.. iP• Telephone: (209) 468-3420 Fax: (209) 464-0138 Web:www.sigov.org/ehd <br /> �IFORt� <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT ` ' }2u <br /> Name of Facility: V ;S +" W C—C Date: lQ f,0/ 1'j <br /> Address: i 04 t m w t City: 4U f t,`T toy, Zip Code: I S 2 UZ <br /> Owner/Operator: M Cq u i. / U\jn ( C v Q Telephone: <br /> Program Element: �0 2 t4 Program Record: �Ca �t1po�2)`i,t Inspection Type: <br /> SB180 Posted n Yes n No Permit Posted TI Yes ❑ No Re-Inspection on or After: 2 P C?, �1 <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> C UY'(eu Cej 2X(a ( U'Crt?t I <br /> m fair �w i C JV S(pma si��m_ . moaJ <br /> Co Avr\y­C> LA V'e nv an +e)LCA <br /> nk PGA d S-\ \ i r\ 1 ,W i7a.W� . V S(.3)-X1; Use <br /> _(Ard ov\\* \A�e CC"MaA_CACA\ CK Ve*VV_6tjjA- QNcte- vo_� LCTAol <br /> 1 Cvc, W � ItIZ <br /> 1 ire C'0-e v i S -�c�2 gnu <br /> l62 0, t 0 n 1s G_ybV,(UA(? ped5 - <br /> Item/Location Temperature Item 1 Location "Temperature <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: 'F Chlorine: ppm Heat: °F <br /> Exp.Date: Warewashing Sink: 'F Ouat. Amm.: ppm Other: 'F <br /> Received By/Title: 4 <br /> EH Specialist: Phone: it �G, '�1,-� it �'I <br /> Time in: i1. Time Out: ` ` U ZJ "1 Page of <br /> EHD 16-24 (2nd pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />