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SAN JOAQUIN CillrY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East HazeIton Avenue, Stockton, CA 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sigov.orcilehd <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />Name of Facility: i -) <br />/ <br />S 6t 4 1 -it I <br />Date: <br />Address: 3cCC) Al (c)i-/A,t bila,vd City: 510 ck , ,rah,01 , t. Zip Code: 1 A c 2A7 S---. <br />Owner/Operator: rS* i) tk1/4../k_. 191.'h-L11,4,16/5-9- Telephone: 0 14 1 <br />Program Element: k 4, (..... Program Record: 02.o D c)2 _o)2 _ Inspection Type: <br /> <br />SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />eA sk.st., Pp ckl ryt ttke eatAA- /4„„,,, u civt_e_*-) L -zin i , <br />cat 4ki---, an YA, car-cc gat/ L.Ve (AAA 1444A-414,1 'pLI,C;1".0-49 / Ne444-4,, <br />6tA 5 hae Zi, C.7 ‘h (z") trY1 *4, cale'") 11 tA I wee-k 6 1 y ,e tyl , f / trn 5i <br />.74 arkid ‘i' 74 /i . Sp-tA"- ier ad kelsk jevAryvi.4 <br />(...D <br />, s , f et/it/4"i: Ak t- , a capy o1 5i fe itrxiiS;4.,,e„. <br />// _20 03 oeite ct/i-e jbs 1L ) icct-tc- ft-e-t,i-) ta.c 0 1< <br />Item/Location Temperature Item / Location Temperature <br />chuyt: 1-1 <br />Food Safety Certification Facility Hot Water Temperature Warewashing <br />Name: cazi,va.„ --1--4a.e., Hand Sink: / ' \ — <br /> <br />- i <br />o F Chlorine: ppm Heat: c <br />Exp. Date: 72 Warewashing Sink: . Quat. Amm.: ppm Other: . <br />Received By / Title: jerti _bag/ <br />EH Specialist: <br />Gall/let, Witki'"4--/c <br />Phone: .5 -4 9 3 <br />Time in: <br />1 0 : itc <br />Time Out: Page of <br />EHD 16-24 (2^d pg) 4/3/13