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SAN JOAQUIN COL Y
<br />ENVIRONMENTAL HEALTH DEPARTMENT
<br />1868 East Hazelton Avenue, Stockton, CA 95205-6232
<br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.siciov.orq/ehd
<br />
<br />FOOD PROGRAM OFFICIAL INSPECTION REPORT
<br />Date: _ z ,s--___ I --i Name of Facility:
<br />Ch.) C'Oje-R I-"<7 j Address: t ,..i s kro...) City: ---ic\-) r \ Q-Ck.... Zip Code:
<br />Owner/Operator: Telephone:
<br />Program Element: k 1/4.03 Program Record: s 39 ,4 4,,,,, Inspection Type:
<br />SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After:
<br />OBSERVATIONS AND CORRECTIVE ACTIONS
<br />l 2_(-\.-7*- -4-_, --\--1-42
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<br />Item/Location Temperature-1 Item / Location Temperature
<br />Food Safety Certification Facility Hot Water Temperature Warewashing
<br />Name: Hand Sink: o F Chlorine: PPm Heat:
<br />Exp. Date: Warewashing Sink: oF ()wt. Amm.: pp Other: .
<br />_-----
<br />Received By / Title:
<br />tik r.)1 k\i`eAr-
<br />EH EH Specialist: ctiok(3.126,....cs_rik •_-!..i Phone: LA b (6 _ 0 -6
<br />Time in: Time Out: \ .,-a 1. Ls PagoN fa ...) ow.. 0 rY1
<br />FOOD PROGRAM OIR CONTINUATION EHD 16-24 (2^d pg) 4/3/13
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