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SAN JOAQUIN COU ! <br /> �. ..o� <br /> 4 ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> �`q•.,, app Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.si-gov.or_ /q ehd <br /> �IFOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: 1 Co f) C,(� umo (U r t Date: v C <br /> Address: '� U G 11�, City: 5.4,.�r.> n Zip Code: <br /> Owner/Operator: Q; 1-�c�1-u Telephone: eq �)o SU <br /> Program Element: ` (0 -,-;!) Program Record: 9'F-UG-}(Z `I Inspection Type: Un�Lq Nz�tti�r71 <br /> SB180 Posted Yes No Permit Posted Yes No 1 Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> ----..___..._....._._...._............._........ - - <br /> - <br /> Tames aVz ITIOCUZ c r) T�(a Q c0 `t _\ka :�A rt 1 1940_ <br /> IDTOIQ C(ARE- r'UgP0 4f, vqi + I-acc) <br /> C od v'�2_ C UU�_i can b.2 cm-e cm ` Tq_ <br /> 6111 awe - <br /> O Y- 11 \.sv-f- o- <br /> X33 <br /> Item/Location Temperature ��` Item 1 Location Temperature <br /> Food Safety Certification F_Facility Hot water Temperature Warewashmg <br /> Hand Sink: ` �i�, of Chlorine: ppm Heat: 'F <br /> --- <br /> Exp.Date: a� �� arewashing Sink: 'F Quat.Amm.: Ppm Other: of <br /> Received By/Title: <br /> EH Specialist: Phone: 46- <br /> Time in: I Time Out: Page of I <br /> EHD 16-24 (2n0 pg) 4/3113 FOOD PROGRAM OR CONTINJATION <br />