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P41'" SAN JOAQUIN COUNTY <br /> �o. .coG <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.org/ehd <br /> <<FpR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: �. - �) fi X11' CQLASU Date: W 2' j <br /> Address: - City:. O fUIU Zip Code: <br /> � <br /> Owner/Operator: c)bP •e Q n l�1 Telephone: "1 �A <br /> Program Element: ` U-15 Program Record: SSR D& } 255 ( Inspection Type: �U on <br /> IS 6180 Posted ❑Yes ❑ Permit Posted ❑Yes ❑ 1 Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> L I(fin S 1= Y 1- <br /> 01-Ne 'C W G y)� U cl n - o i P rliz <br /> ICU -fie, k I 'r <br /> �cx1 "CAP u S b CGW' n o S <br /> 2)0 e" C.:;� <br /> w u4e., wco-fir = I lcm s -- <br /> 3( Curnm\C-�rA \'j,, 0 Iwo, VCR n+ <br /> Item/Location Temperature Item/Location Temperature <br /> Food Safety Certification Facility Hot Water Temperature Ware washing <br /> Name: Hand Sink: V U of Chlorine: ppm (Heat: of <br /> Exp.Date: arewashing Sink: 2(` of Quat. Amm.: ppm Other: of <br /> Received By/Title: v <br /> EH Specialist: je Phone: 12L r 2 C� <br /> ime in: Time Out:a U l� J I Page I of <br /> EHD 16-24 (2ntl pg) 4/3/13 FOOD PROGRAM OR CONTINUATION <br />