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SAN JOAQUIN CoL Y <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East HazeIton Avenue, Stockton, CA 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sigov.orci/ehd <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />Name of Facility: I <br />‘ '?,, CC i VI 6/ C <br />Date: Li / 5 <br />Address: / a) , ,,,,,,e,,,,-,- City: Zip Code: <br />Owner/Operator: Telephone: <br />Program Element: y y 5 Program Record: 0 c7, 515 Inspection Type:Att <br /> 1,-1(2•4-e— i• , <br />SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />_ <br />J.C..• A , <br />1.0 ,_4 4 4 , 4,44.11,i WIMWIDed AA 4441 <br />Aid alibiillret21111 .1M111MTMEIMMIlreffr <br />..; <br />I I <br />( a -Ikea --A d A- 0 A{A.A4/1.,T . ,,...1, <br />..14-(--- Atilt-0c/ aA <br />fvu <br />t -6.-616cei,t(j . <br />de. - LiA/FT, pAk, p ./...e..4/A.I4-y <br />' <br />,0 /24/1.0a0/ <br />ivy\ viA"-e--__ c--e, ' A.c,,,5 ,t-ct-t <br />A 1./l._ )uo_ 4& v a ?1J k J <br />V avvt> QL W-L14-4I-J - <br />iI jv\LaJtk : <br />° ' i ,1^1 <br />Item/Location Temperature Item / Location Temperature <br />. , t <br />Food Safety Certification Facility Not Water Temperature Warewashing <br />Name: Hand Sink: o F Chlorine: ppm Heat: c <br />Exp. Date: Warewashing Sink: . Quat. Amm.: PPm Other: . <br />Received By / Title: .6 4 <br />EH Specialist: — <br />i I <br />Phone: oat_ w. <br />Time in: 7 Time Out: Page of <br />, <br />EHD 16-24 (2,4 pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION