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SAN JOAQUIN COU `if <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East HazeIton Avenue, Stockton, CA 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjqov.orgiehd <br /> <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />Name of Facility: to e -t , c..„ c 4 c }A i 4-"() Date: <br />Address: City: Zip Code: <br />Owner/Operator: Telephone: <br />Program Element: Program Record: FR() '7D5(03(..) Inspection Type: 9 (AA-VI rt e_ <br />SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />0 NC wal-er Cli- ii-rAT w a or 3 cL"A p Dnic- -t-tA-1-1-01-1 <br />tm Vtoki-C-C Stal-eS diroin v- z Thai- IC CCA1Pe c--rd -r-c• Tha- <br />w aske IN o\-e-r 1-0(q- 1 &. V7v ;It!i• wc4e4-- Nein 1-Q4yr:ea _ <br />.11---6I-64:1+44---ax T-11( tociaN \ti 0,S4C v4 0,4-ex C Gin c-t‘n cyzoi <br />Ii-Ni-t) -vt‘,u tiot9e wai-e.A- -ranY- <br />e NO c',17 cAt ii-onJwach Stahcs1,J car-reo4-ed on & 4e <br />a yi2ov ote. cti-ivri na Aest si-rApS.. <br />6 cmrceini- h-eci111- v-eirm-4-1_-.e,vi-cA4c rk 1 and rood t . ceirti-Vi cal-e not cA-N f-s . vtoiintoor\ on 0.-ve ai- <br />cA11 it me.,c • <br />4- can n 01- isgAL F.&rnm't -I- ti ii 1 (-) I-C:0(1)e C -hON <br />.1 60we _ <br />Item/Location , Temperature Item / Location Temperature <br />Food Safety Certification I- ' Facility Hot Water Temperature <br />DC) o F <br />r Warewashing _. <br />Name: 1Hand Sink: Chlorine: pp, 1Heat: F <br />Exp. Date: Warewashing Sink: 120 ,.F IQuat. Amm.: PPm I <br />Other: °F I <br />Received By / Title: • <br />- --- <br />Eli Specialist: 141V ° 91 Phone: <br />/)-(-:CI <br /> ..... 4 4,b _ ,3 4 J i <br />Time in: 0 - 7).4 \ , Time Out: 1 2 1 c t.) Pagel of 1 <br />FOOD PROGRAM OIR CONTINUATION EHD 16-24 (2,,p9) 4/3/13