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SAN JOAQUIN COUNT <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: ,-e j cm A4-(_,0 Date: Cy oi / / 7 <br />Address: c 6, pi „ 7, 3 ,5erlobi A IA1-01 <br />City: Zip Code: <br />Owner/Operator: (4 4 yv\ 4.4.41.4 Telephone: Ci / tio <br />Program Element: i ti .;(", Program Record: 10 g 0 5 i, ., <br />T (I (.1(.061 <br />Inspection Type://it ),,iiiva <br />SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: c 1 I j 3 b -2 <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />LI )1 K H 5 u, <br />1,Ati-c_ 10,4A-V-a-t- 44 ialoki-k 4- ( 0/64 <br />R.e/t.rpvj ovv4 /Up/1)F — •did 161-1-,14-“4- <br />D O d 04-4t-cii,ui-4 Ott", pt . ,,i-e <br />dAthl ",„. ati&ki 1 iiv1 /44,4 om/v/ut ttVJi <br />Li 4:c-fA--etiv,r,t;vviA-f, ,20,\A4 <br />- / or <br />.. 06(Ad— --ii.VL.f- <br />i / , / <br />ptim)---(49Le J <br />(12-e <br />v-vd-- iv.:14/tt p itYo <br />J er-cc,a,,v d <br />Item/Location Temperature Item / Location Temperature <br />Food Safety Certification Facility Hot Water Temperature VVarewashing <br />Name: Hand Sink: oF Chlorine: ppm Heat: 0 <br />Exp. Date: Warewashing Sink: . Quat. Amm.:0 ppm Other: <br />Received By / Title: /0 E' <br />Page/ f) <br />EH Specialist: Phone: g'--%ci v-,----- <br />Time in: CI Time Out: <br />, <br />EHD 16-24 (20, pg) 4/3/13