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SAN JOAQUIN COU Y <br /> tiA ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax:(209)464-0138 Web:www.siciov.ora/ehd <br /> �IFOi<a <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT (' <br /> Name of Facility: ea O m n Co #- (P(oI j 9b Date: 1Q/I rIW <br /> Address: 2-100 t ft cz); n � City: 5��� Zip Code: 52op <br /> Owner/Operator: -Av-1 G CA �C�-,I ,,/� Q Telephone: A5'_!".� n6 <br /> Program Elemen 35 Program Record: ` ��$) 0bZ Inspection Type: `CV r. -f <br /> (42)E) <br /> 8180 Posted Yes No Permit Posted Yes o ��``--''UU Re-Inspection on or After: Y'�v" <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> T11Z fti- wGLS X Ui- TtIZ 2 CCnA 5+nK S <br /> 1� 1 T% k)Li-- -ra \201= u-r . curr2 c)x\ <br /> h <br /> tte &WO VA JZxx ;U is at- 1 kYJf t2) <br /> urr \-* <br /> a� <br /> CVrW - h Ot1'h errmli' )s Tint CT) St1e - N+dtrizatrl <br /> G Gin s.�e air rme-s <br /> ol- i-o L&Gj&�& h?ofm i- cx+ -_w r 11-e gees <br /> ve"ou'A& c -w- <br /> Item/Location __Temperature Item!Location Temperature <br /> o dr a01Rrt- 'Sr I Y- <br /> e car -q2 Ke r <br /> Food Safety Certification r Facility Hot Water Temperature Warewashing <br /> Name: Mol1'1G �ur�In.f Y-i and Sink: 00 of hlorine: PPM Heat: of <br /> Exp.Date: CAI (J`��� '�` arewashing Sink: �� eF uat.Amm.: PPM ther: ,F <br /> Received By/Title: <br /> "•'V <br /> EH Specialist: Phone: i70ct A_!_ <br /> Time in: .j U . A-0 Time Out: i1-11.1 A0 —( Page(of <br /> EHD 16-24 (24 Pg)4/3113 _ _(v FOOD PROGRAM 018 CONTINUATION <br />