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SAN JOAQUIN CC _ATV <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sigov.orcilehd <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT , Name of Facility: EA Not\ici n pcucAvu-) ( no it (A "‘ <br />Date: <br />11- <br />Address: 1 2- '-, -0 \le Y: G:1--U (AL -V-Cii <br />Zip Code: <br />Owner/Operator: t f-rkfrj c 12 ‘Au ri 11 c) Telephone: _1_1_1 -5 4s1 <br />Program Element: Icp 0 0 Program Record: <br />DS 40M CI I <br />Inspection Type: <br />SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />o-14F10)ni- 'FOCA\ ;(1-u4 nc woct cect_coned___ <br />nurtc 01-0 vier) --V-rttk 1-?-0 <br />o'?c,47w.e.d 2A-gr- cc.kkIN v.evd - ecA.k --Vvetic ‘n <br />un-ro-i\Al2. Fcack 02_ -'\--WUNI <br />ono 7c,-€.vacx_oc*jeci <br />Item / Location Item/Location Temperature Temperature <br />Facility Hot Water Temperature Warewashing Food Safety Certification <br />Name: Hand Sink: °F Chlorine: PPm Heat: °F <br />Exp. Date: Warewashing Sink: Quat. Amm.: PPm Other: °F <br />Received By! Title: <br />EH Specialist: Phone: 'lop 4(-- :244, <br />Time Out: C4 2) Page (of Time in: q <br />EHD 16-24 (2n, pg) 4/3/13 <br /> FOOD PROGRAM OIR CONTINUATION