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SAN JOAQUIN COUNTY <br />. o�A <br />' ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />8q�l�dw;� Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.siaov.org/ehd <br />Y_ <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT Hq-23 <br />Name of Facility: S, V"A(-\-Q) <br />' <br />_sis> Date: 11 <br />Address: 1 C OZ O <br />City: Zip Code: q S? 3 <br />J <br />Owner/Operator: <br />Telephone: <br />Program Element: Program Record: 3So <br />Inspection Type: <br />'IcvQ <br />6180 Posted as No Permit Posted Yes No <br />Re -Inspection on or After: <br />`-'°' " <br />OBSERVATIONS AND CORRECTIVE ACTIONS Jim <br />o, s� <br />- <br />Pr v <br />T 1--e <br />\ <br />\e <br />2 % s <br />1-e 2_QL - /"A <br />-Fr <br />3 <br />� <br />y '�:N <br />b C <br />-VLQ <br />L <br />.e 1 2— <br />\ r\k- <br />e o\1 13E, <br />c me;n Y-AbF <br />'Tamperatu're-11 <br />Item /Location '-=__ :. <br />Temperature <br />S18 " <br />chi: <br />39 r= <br />\ l - <br />k <br />"'AC�__I <br />5 Q C A-"; V'; <br />v�z� <br />Food Safety certification <br />Facility Hot Water Temperature <br />_ Warewashing <br />Name: �I, ; <br />f <br />Hand Sink: ; <br />eF <br />lorine: ppm <br />Heat: <br />of <br />Exp. Date: <br />2 _ _ 25 <br />arewashing Sink: \2'_j of <br />uat. Amm.: ppm <br />Other: <br />of <br />Received By ! Title: <br />EH Specialist: <br />- <br />Phone: ._ b\ b — J 0Z <br />imein: \` �—I <br />Time Out: Z� loyy <br />Page of <br />EHD16-24 (2bp 4013 1 1 FOOD PROGRAM OR CONTINUATION <br />