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4Hl" SAN JOAQUIN COW- <br /> ENVIRONMENTAL HEALTH DErARTMENT <br /> P: A • <br /> N1 :< <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax: (209) 464-0138 Web:vaww.sioov.org/ehd <br /> [IF$Ra <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Tom& LOS MOS S 1— Date: 1' -2-1120 E <br /> Address: 0V0 J-11K Sk City: CGStV Zip Code: af <br /> OwnerlOperator. [Q (Au r L0 (f(,Qf�Q U�..�I[� Telephone: -.1]h —•�.}QZ <br /> Program Element: 1 Program Record: + }I r'�^ Inspection Type: COSI .1l�& (Nn <br /> 6180 Posted 0 Yes D Remit Posted 0 Yes 01 Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> 11W S <br /> PRNICU/ 0 'Food C U 1 2S <br /> th SO da, <br /> 3 No a+e - PRW i <br /> wSI iG r�S2Y1 <br /> ItemlLocation Temperature Item I Location Temperature <br /> a�izr <br /> r <br /> Food Safety Certfication Facility Hot Water Temperature Warewashing <br /> Name: and Sink: >F hlorine: u I ppm eat: eF <br /> Exp.Date: arewashing Sink: of ruat.Amm.: ppm r <br /> ther: eF <br /> Received By I Title: <br /> i <br /> EH Specialist: �' Phone: <br /> Time in: 6Hre9_ to ..21 /•t V Time Out: (11, ( O v/v Page of <br /> EHD 1626(2�pg) drdn3 1 1. FOOD PROGRAM OR CONTINUATION <br />