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SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sigov.org/ehd <br />9�IFORN <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />Name of Facility: Z I00 Date: j _ t --I - 2 z <br />Address: kb <br />01 W I I / 1- <br />1Tn <br />City: —r�C Zip Code: <br />Owner/Operator: Ca <br />Telephone: <br />Program Element: 1 b1 Program Record: <br />S (Q S 1 2 Inspection Type: <br />J <br />B180 Posted Yes No Permit Posted Yes No Re -Inspection on or After: 2 <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />bcd co.�-_Q c�� <br />`-� 1 r l G i2SF <br />\)k 1,33 <br />F J 4 O - <br />9- '-'/I c l y <br />51 e o.�e 4 e -F uO <br />i - u ; b dr LAO <br />• e <br />`-1 �,.,� cl � F <br />e-cl cheese- � S - - <br />• v. � • ��e � co�le �1 l <br />'e nlch <br />12 t F ' e k4c L- t `Iop <br />ca l <br />t�Ac dneeS l35"' <br />22- Li <br />x(00 <br />5-02 <br />12 - 1e s• - 50,1 � o = <br />2 - 7s'% - <br />,rem cheese `t I ►_ <br />5e �cA SOA 3-=T — ce : c -h -e 3b -F <br />0 <br />3 c3f3F <br />v� cooe 3 '- <br />\ w ccoole SbF <br />3 conne \2 l F c -1 0O <br />0 v <br />I < <br />- -- ItemlL'oca o _ - <br />�1 C'_Sc_ <br />Temperature <br />2c't E <br />Item / Locati <br />Temperature <br />k> eco <br />1c <br />2A- <br />sz:�� <br />-e <br />z r'k <br />1ZO— <br />Food Safety,Certftcatioo <br />Facility Hot Water Temperature <br />- Warewashing <br />Name: Sq c- A .- <br />_cll*, <br />Hand Sink: of <br />Chlorine: PPM <br />Heat: 'F <br />Exp. Date: 1 �- 1 1 _ 2���2-�- <br />arewashing Sink: 12 eF <br />Quat Amm.: ` , PPM <br />"1 <br />Other: eF <br />Received By / Title;.J •, - - _ „ _ /I <br />W <br />p <br />EH Specialis • <br />Phone: <br />2 -OR _ b11_ V J _ 2 O <br />ZSO <br />Time in: 1 t : <br />Time Out: 1 : 1 Peg of <br />jq <br />EHD 16-24 (2° pg) 4/3113 FOOD PROGRAM OIR CONTINUATION <br />UK - <br />Q <br />n <br />