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SAN JOAQUIN COUN' " . <br /> Q` ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.siQov.orq/ehd <br /> /FORM <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: \kSlOn �56 t7O Co�C Date: 1124/ 14 <br /> Address: f-J s �1.. SL City: SAzu-iD'� Zip Code: 5 02 <br /> Owner/Operator: M �1l TuS�(A-) \14 Telephone: 4}3 .-IISfp <br /> Program Element: S(0-�4 Program Record: � � Inspection Type: r <br /> SB180 Posted VYes No Permit Posted VYes F No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> SUM M old ns_ i vx M i ne . Clean <br /> a dy- TVO Co-b u tt r kC`Pd W'k C V S aA- <br /> 3 �[dtx5 t- th t Lv.- cm- e 1 cw . <br /> - s s n <br /> 0 s vQ i1 UWove ppzwsre i nS i , �cw <br /> alrO cir,l u �uwn+ Vosy ccCRTP-U <br /> 5ed �n G � a Of h`L� Q 'WN d tea 0f9 <br /> aha+ was -IIIie ) Cio,6 c w"Ob G rubber bund strum 1w <br /> U .e,n S o� hod -I ns lcX Ck Wea1 Gt6ta ("nit rP-x fiodO <br /> i cM� 1 n s e c�t1v» 0+ cm Li-+e. <br /> V(d l t)CIW4_ (CA(_61; GT) S i <br /> Item/Location Temperature Item!Location Temperature <br /> 1l�I�r�U NIP- D�W <<o �_, -40 <br /> -- '2c1� TF-V e, c c,�wx- <br /> �-6 r r bU r C sG `'f <br /> c VAi1Y- (07C`t24- 4 I"T - <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Hand Sink: i C)c) o f Chlorine: 2 ppm Heat: OF <br /> Exp.Date: ✓�� �i 1-` - arewashing Sink: I. of Quat. Amm.: ppm Other: of <br /> Received By/Titl <br /> EH Specialist: Phone: n ,3A-k2 <br /> Time in: �I • (J� Time Out: S- Page Z <br /> EHD 16-24 (2nd pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />