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SAN JOAQUIN COL <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sigov.orq/ehd <br /> <br />*").... FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />Name of Facility: —c-.2_ c\N„,\ 0 ,‘, k -Alc- cr 5!) kc, (.,:s- cc, ,..,, k Date: <br />- C) - i b Address: --7 0 cirizL;vc_o( c‘...A' („\ sik_ City: ,..k..ks....0(...ANI.,(.\ Zip Code: q s z 03 <br />Owner/Operator: Telephone: <br />Program Element: kk:). s Program Record: s s zz...---N oktz , Inspection Type: -p • J ;s 'I i SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />1 \-3•P2_ __1.-- \ S ‘-' A \-1 _ -\. m <br />ck \---9-,----0.__44,-"N can--'‘.. A- (--> _12 S ' - i, P ---k-,:k <br />a-sr -0( f--.Q......4-\ -\-‘. 1$‘z,k . . 4 )-4-L.-, P<•,.-e_. • ..r\ <br />.S-t\--‘5---u,kAN5i-N --Vn /--9-etv-)2A- CA F.._\r-N cy\f-N%R % k-M. - <br />C.,0.(--S \ .."-9-42...... C•cs• --\"\-. AreA-P-3 (4 I 9 --`-'cA)--\ A.,— sl,L.1-kly-N -Psze ) <br />(- J de 00,.,Jz_e_rj ,jc- t V--c,\--0 c'r\_)-9-0(...Q_ % <br />--ky-\..) cie- 1 2.,...—. <br />ItemiLocatio Temperature 1 Item / Location Temperature <br />Food Safety Certification 11 Facility Hot Water Temperature , . . , Warewashing <br />Name: 1,Hand Sink: o F Chlorine: ppm Heat: <br />-, <br />Exp. Date: Warewashing Sink: <br />II <br />oF Quat. Amm.: ppm Other: <br />Received By / Title: , QA1ez. <br />' SA CA-k <br />EH Specialist: <br />dr a" • ..• ' 1C1/4.t... <br />Phone: <br />Time in: ct •.c-- Time Out: g ' s el Page of <br />‘..] 0,CYN e- CA l <br />[HO 16-24 (2,4 pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION