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SAN JOAQUIN COUI. f <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East HazeIton Avenue, Stockton, CA 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.siciov.orq/ehd <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />Name of Facility: c co_ffz‘sy3 ip.A4 ciy_c_. Date: ZVI WIC <br />Address: NOVZITioSO1/4 C ity: .1•-() CAt_trin Zip Code: <br />Owner/Operator: • Telephone: <br />Program Element: Program Record: I (0 00 ( 6.0..0 Ci r:5•.1 Inspection Type: 3 ( c)c) cip I Co v Oa In -1- <br />SB180 Posted 0 Yes 0 Permit Posted 0 Yes Dl Re-Inspection on or After <br />--- • . OBSERVATIONS AND CORRECTIVE ACTIONS <br />1—,VITO 1 (.., I'vi ' ICA I 11 )-" STO•t(i... i 0 _,(.., IVAA CA----S i'L., <br />nse-n- 2N i oo) noi-- \-1 cw e cA roLe- -tu Uhe- tile_ <br />WI- S. Union -I- <br />4oea -GI I 0 - 01-co <br />,---, <br />,2) -roc° s tc-ill 0 <br />t,-1020&e4 Ar ttzl_eo 1 <br />aoq - b -.301 - <br />-- o1/4.4(51-- le—le -----.r\--fzum \-01-I liktca S-frAfe 'Ivo+ -\--N1:1 /4,‘ uke_ <br />IN) kzaCt\ZU(.51"4 al-- .1Jta\z_i-- _ -4\QA4 c;11 c) c.-r-c4e *co- <br />'e-kw-Ax-1 1.A DrActoe>r DM ow -1-1‘2,rs, tb 0 ik- <br />1 /4..VD Ce* -IV 11-Le MCA na ai- 0.Au‘ i-- ilvtAN ) al-NO 0-1)2, <br />cto-leCt '-e-o DtktS c CAn b.e NA <t-d \-A/ 1-11-P, uU;tc- <br />aid .T110\1 * CM 1 I-- toFi-\-- -thfl, raLD -niu c-t- <br />.ci,A \I -1 1-Aq 1\e- <br />Item/Location Temperature Item i Location Temperature <br />Food Safety Certification Facility Hot Water Temperature Warevvashing <br />Name: Hand Sink: .F Chlorine: ppm Heat: °F <br />Exp. Date: <br />---\ <br />arewashing Sink: Quat. Amm.: PPm Other: °F <br />Received By! Title. <br />••• <br />40011#* -41 b..1 EH Specialist: -0 Phone: 9_0ei .._ AK) 5 il <br />Time in: Time Out: fa, 45- Page o <br />EHD 16-24 (2^d pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION