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SAN JOAQUIN COUOY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East HazeIton Avenue, Stockton, CA 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.siqov.orq/ehd <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />Name of Facility: , . i A s •••/1 -I Date: tt/f ;fr./ kt- <br />LV7ta r",k1 e;or ‘.t.e., cipseim <br />Address: cc., -7\AfArev- , City: 1 1 n.4 _ Zip Code: et6-Lt.1 0 <br />Owner/Operator: Telephone: Ak—, <br />Von (174/4 <br />Program Element t le 77-t, Program Record: • V Zr otCY----C\ Inspection Type: CIO i <br />SB180 Posted OA No Permit Posted No Re-Inspection on or After: <br />I / <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />/tL,‘(- "1/4 M'A Lbtki <br />YI a0 va-k (1121..7 <br />Lp oorvoivee, v\v violtlytct& @, 4iii ki• <br />Ltr ati, 4T/ 11.-St.c,- F^.- - 70 Z.-el em Ge,-- 441 6WV,..- trees" reA41.14- <br />1-10 Waco' IV% -EA-, An frfpc11- ct# 4c) CANYVA/16 <br />Item/Location Temperature Item / Location Temperature <br />'1 -.N- 1fv..(., ‘Ix...70.ty-- -.4-e. T...,,,,,--- Lt; — <br />la,o r <br />Food Safety Certification Facility Hot Water Temperature Warewashing <br />Name: leprk vvv‘ Hand Sink: it) 0 .F Chlorine: ppm Heat: . <br />Exp. Date: <br />(.i% /I-7P T-- <br />Warewashing Sink: f‘ -L,L . Quat. Amm.: -y) ( ) ppm Other: . <br />Received By / Title: Calk <br />EH Specialist: ,„,.V.0.26404.0,...,„%,..., Phone: .074/ ck _ 9 <br />Time in: c- . 0/1 Time Out: r—, 7 f) , Page of <br /> <br />v ObIA. GI .. ..‘"/ <br /> c iNn <br />EHD 16-24 (2nd pg) 4/3/13 <br /> FOOD PROGRAM OIR CONTINUATION