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SAN JOAQUIN COUP <br /> P <br /> a a ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> meq.... .,..•;P Telephone: (209) 468-3420 Fax:(209)464-0138 Web:www.segov.org/ehd <br /> L/FORCE <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: 1 '; A�- ; L 9 j e3V1` Date: 2 <br /> Address: Z W City: Zip Code: <br /> Owner/Operator: , `fir,v� G�e Telephone: <br /> Program Element: i•� G� Program Record: Inspection Type: �Uqe` n <br /> b1, <br /> SB180 Posted Yes 1 No Permit Posted Yes Re-Inspection on or After: 11v I 1 <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> �+10l Ucjhs Cep, cs�-7fi <br /> G s cxet n ftx- firxe v\A)ciclw Ukx.4.e.. <br /> __..-.-...-.........._..........-........ <br /> -- <br /> - th s S _v_0 N LLe CAi- z c cin i <br /> Item/Location #.Temperature Item/Locatior Temperature,,; <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: Chlorine: Heat: <br /> 1 .-L. (j rug, L' F Ppm <F <br /> Exp.Date: / I arewashing Sink: .� of Ouat.Amm.: ppm Other: of <br /> Received By/Title: <br /> EH Specialist: Phone: CL� <br /> —------- --- _ I <br /> 0- <br /> Time in: (� ,) Time Out: 35 Page of I <br /> EHD 16.24 (2^ pg) 4/3/13 FOOD PROGRAM OR CONTINUATION <br />