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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.siciov.orcilehd <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />Name of Facility: rt) i'Ci'`-e‘ Date: i/ <br />Address: / 3 j 4 ct,r"Ltevyvit/vcie City: Zip Code: % <br />(1-0/irif,a4 <br />Telephone: Owner/Operator: tch <br />j&gfam Program Element: f Le 3 C Record: 0 5/ t gif Inspection Type:/lact-kv <br />SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br />-. OBSERVATIONS AND CORRECTIVE A . <br />--ila / y" <br />VrIAJ ; A I 71-5- <br />p.ve,c„i,e <br />u7( , ,A(454,,-ti/L5e___ <br />KI, myfrv-L_c. , A1,1 ------- Y2 ,frvvt-C-- '/ <br />, <br />( <br />t-i3t1 9-' fivW"04 d-e <br />61. I <br />14 C4.1 `IeLe4) <br />rñ 6' crviacr cA.A/ g--GeaXc 41LY IA)A,c;t7\ A , .I.- <br />ik. 0 ir i atil_ ,/vr-0-1" / e e;1 <br />I ,410 4 A-di..../ .dIf It .4- a,tf kt-e-epc,a- grie 4 Ar, , , <br />fiiiir / , 1 -P/V17 t <br />P i '7 o1/44 guo . 1 - ' ato A ‘,61--utvt. 1/ , , r <br />1 c., PI> <br />irr y i r <br />, <br />t " ---4?1 a WI il — L' .0 iumfloylvi If <br />Item/Location Temperature Item / Location Temperature" <br />adr A a,4 4. I ./i - _,,,„ t1// 71,/i, ..1,-1,t,a - 14--C A_ <br />Food Safety Certification Facility Hot Water Temperature ... 1 arevvashing <br />Name: Hand Sink: <br />1 <br /> <br />I E <br />`F Chlorine: ppm Heat: `F <br />Exp. Date: Warewashing Sink: 1311 . Quat. Amm.: ppm Other: °F <br />Received By! Title: <br />a/ d il EH Specialist: / r r Phone: <br />Time in: i 1 1., -7. J <br />t Time Out: Page2of ) <br />END 16-24 (2^, pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION