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SAN JOAQUIN COUN v� e�'b� ✓k�Q ,2 � <br /> ENVIRONMENTAL HEALTH DEPARTMENT,' <br /> _ 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • �4.. . �P. Telephone: (209) 468-3420 Fax: (209)464-0138 Web:www.sigov.org/ehd <br /> jib <br /> �iG <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: - C, (>T , h ;, ` (�C; Date: <br /> Address: 2G Cr L %Z1 I n City. C Zip Code: Cl <br /> Owner/Operator: �ui teCinC•1 �'+ �CI Telephone: <br /> ( - Cly Z74 <br /> Program Element: + Program Record: �j R ^Z� Inspection Type: P-WJV) 1 `-e <br /> IS B180 Posted 21Tes ❑ Permit Posted ❑'Yes ❑I Re-Inspection on or After: <br /> -------- <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> "1 ' AX S' 1 S ti 1C. tDC 01 <br /> IF-CW ICWCk Cod r c-01 <br /> ��fih In "0cloo Cf i <br /> _-1(�.e -�1,Q UW`tl,Q�' � 11C1t C`Yl (ifi1.� S•1 CAS O�- ��- <br /> La'F- rn <br /> o� T6 <br /> Item/Location Temperature Item!Location Temperature <br /> 4 ,,i r (00V)(Z <br /> Food Sa„fety Certification Facility Hot Water Temperature Warewashing <br /> NaU CU nU alt I Q Hand Sink: l of Chlorine: flv(I I ppm Heat: of <br /> Exp.Date: 57/11/ <br /> 15 r arewashing Sink: 0 j(J of Quat.Amm.: ppm ther: of <br /> Received By/Title: JQ�1 G\ u` <br /> EH Specialist: Phone: _4 3 - (G <br /> Time in: ( -L K 7j A Time Out: 1 Page�of Z <br /> EHD 16-24 (20°pg) 4/3113 FOOD PROGRAM OIR CONTINUATION <br />