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"C'q!IV <br /> SAN JOAOUIN COUN <br /> z. .. ENVIRONMENTAL HEALTH DEPARTMENT <br /> a: .a <br /> - _ 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax:(209) 464-0138 Web:www.sigov.org/ehd <br /> L/FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: C"L 6c- \1 3r'� `.f Date: 2_ aa) I S <br /> Address: 10016) •,� '� (�,�p City: Zip Code: PlS 2�O <br /> Owner/Operator: e ani 1 1 1 V-\ <br /> C CTC- C o lz Q ' Telephone: _SbGq_ b(OS ko <br /> Program Element: 1025 Program Record: b 2 y` Inspection Type: <br /> S6 <br /> 180 Posted es No Permit Posted es No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> �... L <br /> n c <br /> Item/Location Temperature Item I Location I Temperature <br /> e 1 he - <br /> Food Safety Certification - Facility Hot Water Temperature Warewashing <br /> >�__........ . .__: _ --- - -- — <br /> Name: \ e C�� Hand Sink: 1�,y 'F Chlorine: ppm Heat - — F <br /> Exp.Date: l _ Z�_\ arewashing Sink: `\ Quat.Amm.: �,T{1 ppm Other: `F <br /> Received By/Title: 7aI�/� fz VV��JJ --- - <br /> EH Specialist: <br /> Time in: 1 CA Time Out: Page2of 2 <br /> p <br /> EHD 16-24 (2nd pg) 41303 FOOD PROGRAM OR CONTINUATION <br />