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SAN JOAQUIN COW <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: <br />044/1-•ni ' Date: if i G ( 1 s _ <br />Address: S ti4....(41,470_1...._ City: <br />..4-C41/44—.1AJ <br />Zip Code: <br />Owner/Operator: 0 $11 4.1A Ia.& _ gaiTelephone: s-7 a ..., I 6.- / s <br />Program Element: Program Record: Inspection Type:** • <br />"P SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br />OBSERVATIONS AND CCECTIVE ACTIONS <br />i rlo-1 es, <br />rietAdi ixeitudi dx <br />e-eik., pe*4 pik.,66,4,41 <br />i v of - A-4.a 4 / -;_c-deup _., ;1 ,,,,,,, <br />AA owti / GI L -- <br />ie.... rt ' e‘iyjk .4-4. #7 e, I, _ <br />:-2,.....4Act_ ST$. a00___W2-77- <br />,C17 <br />& 1 LI a. 1•=•••• <br /> <br />toztl:h.„_, <br /> <br />IO ç. <br />(-W (-4,t icz-kt.„ 30"f- i'A-1 , oie :as, pelt <br />gei ea/44a, tkaue, ,4t4h,,,,...-.1 , 14-16-.424___, pt Lei Are-ZIA_ - /140/6L 1 p 4w&,eivrt Ivvue_ 46414 trek__ -4.1-Akti i t 441,...,41.7eit.a., kik, iNr7t"- <br />lu. <br />Item/Location Temperature Item / Location Temperature <br />Food Safety Certification Facility Hot Water Temperature 1 Warewashing <br />Name: Hand Sink: ,,F [Chlorine: ppm Heat: L <br />. Exp. Date: Warewashing Sink: C F Ouat. Amm.: ppm Other: <br />Received By / Title: <br />EH Specialist: <br /> <br />Phone: 904_ 4j '._,c::.?, )141-151l.._ Time in: 71 6 <br />Time Out: St ,fr <br />Pagef / <br />BAD 16-24 (2,Ipg) 4/3/13 FOOD PROGRAM OIR C0144ROATION