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o4R"'" SAN JOAQUIN COU. f <br /> y ENVIRONMENTAL HEALTH DEPARTMENT <br /> a: <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sigov.orq/ehd <br /> <<POR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: �ta �• Date: ;�_-3�5 <br /> Address: HW J City: C Zip Code: <br /> Owner/Operator: 7 cJ Telephone: <br /> Y-5 Viol r-0 c{- r .� n - 1-� Zf 6-;--'�_q 7 k <br /> Program Element: (.0n Program Record: Q 0 07 <br /> ,.2 2 Inspection Type: Ro W,-6 ell.'._ <br /> FB180 Posted T),Yes 0 Permit Posted Yes 711 Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> VLA >' <br /> C.Orlr` G ko3 r-eS; &,-Q- c Ua rZ and <br /> Sol►vi -f i-zt <br /> `11ti e r Y-n4 rr•t A-e..r' (_ns e o,o I-e-r vs no CLc CZ44Y rt , <br /> O _eX . <br /> G /,-4-r,),,(- C—toor <br /> ri o►�w' t�-Loe-t-5 0 CA- 10 <br /> -Fords . ro4e-fid <br /> 6 In r cat bu S 7h t- <br /> n GooCe r pt.a's t c,of-pe r . C LA or n 04h <br /> v�r5 2,-y- <br /> aw o Le r120 � vie » a <br /> Aze V- t vaWe-Atl Go Y-S no 4 bib a Jqo '0ma u� f <br /> �.� rx.t.rtc n . <br /> ---- ------- <br /> Item/Location' Temperature Item!Location Temperature <br /> aXY4 10, <br /> Food Safety Certification Facility Hot Water Temperature 7�_ Warewashing <br /> Name: -� Hand Sink: LFat. <br /> rine: -..--� t �tYr` <br /> ll°1 ��or� �� o /00 ppm - )r7 F <br /> Exp.Date: ar a hing Sink: ` oAmm.: ppm Other: of <br /> Received By/Title: Y� <br /> v = <br /> EH Specialist: ^ y Phone: <br /> Time in: �1 ,� Time Out: `O 7ti Pagetf <br /> EHD 16-24(2ntl pg) 4/!3//133 V FOOD PROGRAM OIR CONTTIINUATION <br />