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SAN JOAQUIN COI, '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.sigov.org/ehd <br /> <<FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: V t7 lt7cAn c) vT�j I .A� �; Date: (G 7 <br /> —776 <br /> Address: .-3 ` rrA 11�,,`i-t T' City: tZ5TZip Code: G,rx <br /> Owner/Operator: LA <br /> `V�1 u V l GDo Telephone: 0� �¢ <br /> Program Element• qo-; Program Record: a7 TbCC Inspection Type: F-CXA . 1`eo <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: ` W Q <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> I -MCA ti Cs ,�, em S(An di _\( S GvW s1cLe d j- Tpak "' <br /> i -b nW-P, fiv <br /> 2 t4c) W 04jgT Oaf- *-0 wcLS V 6pq <br /> CCA Vl- b0r)dVr&S>b S b v n-hI i i <br /> 3 CA VOOd Cctra -fir 01'lI1 . IPrS <br /> -If cannv+ p. 4 m'\-V- yrrVO U rein S c b <br /> cue <br /> s : Temperature Item.J Location Temperature <br /> Food Safety Certification Facility Hot Water Temperature (_ Warewashing <br /> Name: •r1 1_ Hand Sink: 'F (Chlorine: ppm (Heat: of <br /> Ii1CJ\ Cl�1�..1�V1 <br /> Exp.Date: 11/2 arewashing Sink: `F Quat. Amm.: ppm iOther: °F <br /> Received By/Title: r ` <br /> EH S ecialist: Phone: <br /> Time in: 10 Time Out: i n rr tOTJ Page lof <br /> 0 ' <br /> l . <br /> EHD 16-24 (2^"pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />