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"- SAN JOAQUIN COUNT,>Y <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.sigov.orq/ehd <br /> 4C1FORea <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: C-f-V iLl P r1dVQ - - 3 Date: Iv ALI <br /> 5` <br /> Address: �,!_� CCk� City: �cic_ �! Zip Code: <br /> Owner/Operator: rr'PGh C) �kGl `(J1" Telephone:A _��wS <br /> Program Element: 1(0� Program Record: () ct Inspection Type:�t <br /> SB180 Posted Yes o Permit Posted Yes No L— Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> FQC01 LACIVO O nGl M00 OS_ bISZn-hn <br /> r-em wmS I-gyrfft nut un 54C. k Ai n U an <br /> Item/Location Temperature Item!Location Tempera#ure <br /> -- <br /> Food Safety Certification IFacility Hot Water Temperature Warewashing <br /> Name: (Hand Sink: F (Chlorine: ppm (Heat: �F <br /> Exp. Date: �_we_wa`shing_Sj_nk.- F Quat. Amm.: ppm 10ther: 'F <br /> Received By/Title: <br /> EH Specialist: Phone: <br /> '_ <br /> Time in: �I �!� Time Oul ,�U :Pa <br /> of <br /> EHD 16-24 (2^^pg) 413!13 11 FOOD PROGRAM OR CONTINUATION <br />