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CrA4, <br />SAN JOAQUIN COUN1 . <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East HazeIton Avenue, Stockton, CA 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjcpv.orq/ehd <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />Name of Facility: (.7 k p Ec r,g,so #1, 1/41Atatql CSP0V-410 <br />Date: 12,..70A <br />Address: -2.5-r) Ai LA415cok til <br />Zip Code: C ity: grioed4r.s.‘ 015,z 05- <br />Owner/Operator: /- egitimk 1 Telephone:0.4.46 <br />Program Element: Program Record: viLos 0 Li 1-4s- Inspection Type: c.( <br />SB180 Posted No Permit Posted eD No Re-Inspection on or After: <br />t-7,1 ° c- wch, cotA a u . <br />; <br />- sksifes -zoo NIT ilfAe t 1c. t- <br />k -- <br />- Da.- <br />T• -0 4 CrAehArci.40 11ml fxsc4A41 c`ier 5/30 77-VZ 3 <br />V(4.3 tokt4s Le vsq.&KA S,7-8„‘ . ciierto-ect <br />C.) <br />C1) tr...4•0-1k-Sc 1:e5 104"- 471°A <br />Item/Location Temperature <br />Food Sa4-Certification <br />( Dv- sif <br />fin bid t.-41.4%; <br />(A,„k irt- 1,•44E, ' <br />gO'F <br />Facility Hot Hot Water Temperature <br />,Hand Sink: °F liv <br />arewashing Sink: (2. °F <br />Name: <br />Exp. Date: <br />Chlorine: <br />Warewashing <br />Heat: PPm <br />Quat. Amm.: PPm <br />°F <br />°F Other: <br />Received By / Title: <br />EH Specialist: . Phone: <br />Time Out: <br /> Page of ime in: <br />\o'1_' <br />ID 16-24 (2,1 pg) 413113 FOOD PROGRAM OIR CONTINUATION