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°"�" SAN JOAQUIN COUP <br /> • '.P.. ......0 / <br /> '•QG <br /> a` ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.s'gov.org/ehd <br /> �l FORa <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: rI S <ro , c CA0--- Date: 112-7-114 <br /> Address: �0'7� �\Nf a(✓; City: Sfio ficTl Zip Code: �,� I - <br /> Owner/Operator: -f-(TQ 'q)cyj- 5 CC' Telephone: n}�'� _C,V�S- <br /> Program Element: 11'W00 Program Record: C 60 Q �- q � Inspection Type: C CT) T)1(')I n•j-- <br /> SB180 Posted Yes - No Permit Posted Yes _ No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> g 'QC T. S� 11�� <br /> - Sara(Aeff\gnV na)laro, + Com icain-�- <br /> obselv.e swod w x and sipginq )n 1 cid _ s t d <br /> n0-� Se-rv4e cps,4 _'0jn-)i2 on -M\" ChdOS . <br /> — ft-ro Saw iX SatoG l;v� �x G wP�i� UrY,1 QQCJF� <br /> A U_ lacl `�S \4N n ."a C* nd v F W <br /> 1 (Z hit 0 s 1' X ,-,�% i 1 Ik -CA <br /> s �-in rr��x c�,1c�C� a�S �n a 1�G �,�a1 �CSS�i� •ac <br /> Item/Location Temperature Item/Location I Temperature <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: of Chlorine: ppm Heat: of <br /> Exp.Date: Warewashing Sink: of Quat.Amm.: ppm Other: of <br /> Received By/Title: <br /> t <br /> EH Specialist: - Phone: Cm <br /> _ <br /> Time in: l . `x;l Time Out: t : �G Page r.of <br /> J J <br /> EHD 16-24 (2nd pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />