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SAN JOAQUIN COM' <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 /> <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />Name of Facility: 0 Go_u oie 0 Date: LI / c.:// <br />Address: "cto 0 t City: ct ra 1 n9 \Nakt city: _c5cy..1-0-n Zip Code: GI c-,20s— <br />Owner/Operator: tl li c:‘ a Guy._ viell° Telephone: <br />Program Element: I co o ?., Program Record: c \,,z 0 0 g_ 2 0.4_0 Inspection Type: CURViCkii011. <br />,SB180 Posted 0 Yes iii Permit Posted 0 Yes 0? Re-Inspection on or After: <br />- OBSERVATIONS AND CORRECTIVE ACTIONS <br />Lic.e/nw # I 21-2- Pt \ <br />CO Wad -me DtorLP/r s S nang- a Ck+- t. euSi- 1" 1 +0 170Th STC1CS <br />ep-V <br />c,ti1 /4R., 1yA2-trirt a-c-ker --e-e-- Oi- <br />1- 202 I S ratl • ?t : I (4035 <br />* 'NUL Vv CA p TEA' i CA Ski inctc,t1 \ial-ed - CC:0SW i-o-b011 ir) re-up <br />i--1- f er--rn MI &0111.0 onall-f- <br />, <br />Temperature m / Location Temperature <br />9- ckr -1121)-e- 1 41-- <br />1 cl r .1T-ute, n-rif <br />Food Safety Certification _ . <br />Hand Sink: <br />Facility Hot Water Temperature VVarewashing <br />Chlorine: ppm Name: \ ICA CA 6 UOTOAr f a 0 oF Heat: °F <br />Exp. Date: q/7.1/ c Warewashing Sink: t lc .F Quat. Amm.: ppm Other: °F <br />Received By / Title:0/ <br />EH Specialist: Ai. <br />-ay.. Pao AI Phone: 1_0 cf .4 e,43 -34,414:, r. ' alr -- sK" g y <br />Time in: <br />40 1 <br />Time Out: cr. co Page( of 1 <br />END 16-24 (2,1 pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION