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SAN JOAQUIN COUN <br /> � •.OG <br /> Z� ENVIRONMENTAL HEALTH DEPARTMENT <br /> tll: X <br /> _ = 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax: (209)464-0138 Web:www.sigov.org/ehd <br /> �IFORi� <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: -j CAI I(�iP 0 2 _� 2—_ Date: <br /> Address: ��A�, (` }- City: Zip Code: GK <br /> 2/�( <br /> Owner/Operator: `TV J Telephone: GLV,�D C <br /> Program Element: U Program Recor Inspection Type: C (�1G'nr <br /> 8180 Posted ❑Yes ❑ Permit Posted ❑Yes ❑I Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> - <br /> \v a h S v,j'ifh w o r m Sia <br /> aarc WQtVefle <br /> - Wop Yq-WOW& r � c�,PP�t <br /> 0 ^S1Q fel r tL 1 Q "F-Fc�r Is ceeG- b2 fc/re <br /> t h 1_W S Ur-r%-r0 <br /> TA P-h on WOC6 W heAl CGO VA h <br /> Item/Location Temperature Item 1 Location Temperature <br /> Item/Location Item _Loc <br /> -- ............ _._....... . <br /> .. _m , <br /> ,,.m.... <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: of Chlorine: ppm Heat. of <br /> Exp.Date: Warewashing Sink: of uat.Amm.: ppm Other of <br /> Received By/Titl ' <br /> EH Specialist: Phone: <br /> coq- b�3 6 <br /> Time in: Time Out: Pag9 of <br /> EHD 16-24 (2n°pg) 4/3113 4 <br /> FOOD PROGRAM OIR CONTINUATION <br />