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SAN JOAQUIN COM L-k3C.9,-X <br />ENVIRONMENTAL HEALTH DEPARTMENT fQ <br />1868 East HazeIton Avenue, Stockton, CA 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.siciov.orcilehd <br />U ,5V\A-2_ <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />Name of Facility:CosAcs.:3 "V____\' i\ \,4e. VA- \..,c.,- cc,( ( --\ -2* L'•;19 32.S .'i. 2 Date: k 2 <br />City: waL As Zip Code. Address: v•)__\(...) —TO( <br />Owner/Operator: C s -.> <br />Telephone: <br />Program Element: \ \03 Program Record: s -R.ciq 2 Inspection Type: <br />SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: (UT) <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />-1 \ , -;- ..‘,....)c - <br />. <br />') CA CA Q.(,-CL- C7.4.s.lk.)C/‘..SZ CIZS2- <br /> Item/Location Temperature Item / Location Temperature <br />V - • k & 7 Crc_ 3 s, F <br />Food Safety Certification Facility Hot Water Temperature Warewashing <br />Name:Hand Sink: ? .F Chlorine: PPm Heat: . <br />Exp. Date: a _ k:e7, Warewashing Sink: k3*—, o F ,Quat. Amm.: ppm Other: . <br />Received By / Title: - , <br />....- <br />EH Specialist:Phone: Li bca 0 --z _ <br />\C"i'--92._ --,N.,---, C. 0-z9ti"-{Y(C.- <br />Time in: - - ' Time Out: C"' ' 2 t _ Page of <br />t3 -3‘Q"'LIQZ, <br />El-ID 16-24 (2nd pg) 4/3/13 <br /> FOOD PROGRAM OIR CONTINUATION