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on4t "• SAN JOAQUIN COU& <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> / 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> // d4ti aA�`p Telephone:(209) 468-3420 Fax:(209)464-0138 Web:www.sigov.org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: N n}o r CaA-&& ng jTttDate: A/q/ 14 <br /> Address: "�—�}�i.Vil�(sn S�" City: 91bZ/V tZM Zip Code: /l1/2O(p <br /> Owner/Operator: V inePl,t31- 1hU11�G1 S Telephone: " 0, 124-1- <br /> Program Element: 10D--:) Program Record: R oo to$ -+-E> 4 Inspection Type: Con&NA0r- 0 <br /> SB18D Posted 0 Yes 0 No Permit Posted 0 Yes 0 No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> L. 4211 2 <br /> i 1`oa1cw, a -,-oair and eA- 'IvwP�1 0 cA4- -n,e wash <br /> v-ovi sIns on 1xJm C C" of the, Ca rt- <br /> ow r.elr ond fnl[Aki <br /> GtN IcArl3re , ond1 lAG11� 1j <br /> pp-"IX G food Manu t,s Sa C C-4-�+itc4 'in (oo d <br /> "Eal ok c o �D Ott b 't-rh num cir\d dd cess _ <br /> Lw }Ao *oVAing fmdg heed to be- <br /> QV- <br /> 0V- to i d-F -F-V e of 64 14, -- <br /> I& Glib 1033 <br /> Item/Location Temperature Item/Location Temperature <br /> a r *"uq*"(:iPec+e-<- "` - <br /> Food Safety_Certification Facility Hot Water Temperature Warewashing _ <br /> Name: and Sink: i ()U .FChlorine: PPM Heat: 'F <br /> Erzp.Date: arewashing Sink: -F Oust.Amm.: PPM Other: -F <br /> Received By/Title: 'Z - <br /> EH Specialist: Phone: n IP_ bf,-3¢ ,(7 <br /> Time in: Q). �5V Time Out: p„ A,l Page of <br /> EHO 16-24 (2^P)) 4tV13 V `'T� FOOD PROGRAM OIR CONTINUATION <br />