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oiq"Wff SAN JOAQUIN CQ . f <br /> Q` ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • c... �P• Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.siQov.orq/ehd <br /> 9��FORN <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: t vwC) kCon V-c'U Date: 47/' 77 <br /> Address: City: s � .1 zip code: q(502_0'0 <br /> Owner/Operator: �U G O Telephone: �t <br /> Program Element: ' ` Program Record: ri b\ Inspection Type: w--h n e— <br /> SB180 Posted Yes No Permit Posted es No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> j he �1f1� iS <br /> G 11 m'+ca S Uh r tis_ C yr r - <br /> CA�,e � - vn r nc,2,i fih <br /> a M <br /> � (untti <br /> vn fiCjl c��l- C n <br /> "OCA,i Ge ,e n(A- uv)"zo r cNgP r _tt> of <br /> Ct1i v�e n di- r� s� _ MA r.1 C <br /> - <br /> -trv,c vjo? . <br /> -SCS I'lt fi vk-P c�c� <br /> Pr/ii lit 94C <br /> Item/Location Temperature Item/Location m Temperature <br /> cwt at) <br /> Ltc i f� <br /> Food Safety Certification Facility Hot Water Temperature _ Warewashing <br /> Name: - Hand Sink: f 'F Chlorine: G ppm Heat: `F <br /> Exp.Date: Warewashing Sink: -� L of Ouat.Amm.: ppm Other: of <br /> -- <br /> EEHSpecialist: <br /> d By/Title: tr t�rye't W �1���t� <br /> Phone:: I! ; Time Out: i 1v:� Page f of <br /> EHD 16-24 (2nd pg) 4/3113 1 FOOD PROGRAM OR CONTINUATION <br />