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SAN JOAQUIN COUNT <br /> 2-+ ENVIRONMENTAL HEALTH DEPARTMENT <br /> _ 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> ..: - ;c• Telephone: (209) 468-3420 Fax: (209) 464-0138 Web:www.s6gov.org/ehd <br /> q�lFpRia <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: D n 5 Date: _11'11blll(�_ <br /> Address: �0 q City: S ��r f�.n Zip Code:�21 7 <br /> Owner/Operator: U 9 U �O C�1 S IN U "T—� Telephone: n 7- —06�� <br /> Program Element: 1 Id(J 2 Program Record: sty �+2 (52 Inspection Type: `(urn SV 1 " <br /> 6180 Posted ❑Yes ❑ Permit Posted F ❑Yes ❑f Re-Inspection on or After: <br /> F <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> I e, I YN <br /> n.e W <br /> I n U ,( P-r \ON eA i C.P_ ur o+ex a+ <br /> v1 s �S i h.S i n jhu --- <br /> -� <br /> e*_ 00S IS'WO in 11Q, wCMV_A'S <br /> 9mov Q <br /> = <br /> Item/Location Temperature item/Location y K ' 'r Tem rature <br /> CC6LJ9__fz_ W's <br /> C1'r ANO I IL "r) rocCaR, 41� <br /> /T <br /> oodSafety Certification Facility Hot Water Temperature <br /> ,;a �. :� Warev�ashmg <br /> 'Non <br /> ------_._. - <br /> Name: 1 on �,�/ U'' ,- Hand Sink: � 'F Chlorine: �,` ppm Heat: OF <br /> Exp.Date: ("A <br /> / I I } arewashing Sink: I '� j OF Quat.Amm.: lJ ppm Other: of <br /> Received By/Title: <br /> EH Specialist: Phone: 49 C)L?— .469 _ <br /> Time in: ( ,1 Time Out: I �7JU Pagel of r <br /> `t ✓ I <br /> EHD 16-24 (2n°pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />