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oe¢"•N..F SAN JOAQUIN COUP <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />• r... iP Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sogov.org/ehd <br />9Cl FO P� <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />Name of Facility: . A <br />U t CA <br />Date: <br />Address: nl 40 <br />V" IF uY �- City: <br />r.-;Dcr- fon Zip Code: C/ <br />lV <br />u(d <br />Owner/Operator: '1� <br />,—,1 at.) y - ,l <br />` <br />Telephone: E <br />.}-q'bo) <br />Program Element: I b O?, <br />f <br />PPrrogram Record: \S ()U G'� }2 <br />Inspection Type: r�&u_"'I�U,.LtUh <br />1 `tet <br />B180 Posted Yes No <br />Permit Posted Yes No <br />Re -Inspection on or After: <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />r-iclnsre i� S <br />t aIr <br />15 - H"�-- WOW I wry cr 6eivw <br />- <br />ivUAe : N k <br />T�P-}0 <br />1e fimweLAicn- <br />D)- <br />nIo s. <br />rid <br />c <br />Wr pM+ <br />1'r Ole ofih &ji <br />1\ am <br />e -S ri P <br />UT's CUrA \N -tKl <br />o <br />� 2 <br />\s&MQ' : <br />Thi tee <br />v >� �s U► <br />�' = 1 r3� <br />Item/Location. <br />Temperature <br />Item/Location <br />Temperature <br />Food Safety Certification Facility Hot Water Temperature Warewashing <br />Name U ,�� r ��',J..t Hand Sink: (JU <br />�1 tD <br />�F <br />Chlorine: 11v1 I ppm <br />Heat: <br />Exp. Date: 3 �/ <br />arewashing Sink: 2 <br />'F <br />oust. Amm.:I PPm 11 <br />Other: <br />Lj <br />Received By / Title: <br />EH Specialist: <br />Phone: G - <br />46 <br />!me in: , v 1 <br />9 <br />Time Out: ry _Z4�- <br />Page(ol <br />EHD 16-24 (2^ pg) 4313 FOOD PROGRAM OR CONTINUATION <br />