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? •�aG SAN JOAQUIN COL <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.org/ehd <br /> �/PORN <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> me of Facility: C CA C h 0 <br /> tvi 11 hj� V Gnx� Date: 1 <br /> dress: 4 T U i fmun f e- City: �}�, �-� Zip Code:`�15 <br /> finer/Operator: •lipco G CTa 1 v 1 - 1 v Telephone: <br /> gram Element: I CPQ Program Record- ,/ O0 o r _�cc Inspection Type: <br /> 180 Posted Yes No Permit Posted Yes No �J U Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> C>Cj <br /> ((44 1 cion+ , Acx av <br /> +- 1%e, t-1cb <br /> ver v <br /> S G ; �� Cu . i Cv)fi n <br /> t cArel in " Q.rm'%+- <br /> Item/Location <br /> '% -Item/Location Temperature Item/Location . Temperature <br /> Food Safety Certification Facility Hot Water Temper re Warewashing <br /> ie: Hand Sink: of Chlorine: ppm Heat: of <br /> Date: Warewashing Sink: of Quat.Amm.: ppm Other: of <br /> eived By/Tit <br /> specialist: Phone: -GCA- (P /1 <br /> 3 in: `�, Time Out: Pagq of <br /> 6-24 (2n1 pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />