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SAN JOAQUIN COUNTY <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.orgiehd <br />FOOD PROGRAM OFFICIAL INSFECTION REPORT 2 ity_. Date: 77/7)43p.3 Name of Facility:-let COS EA its- m 5- Zifi <br />Address: 73 6 , 5, „J.. City: cSI-Dcrer") Zip Code: 502_0.3 el . <br />Owner/Operator: Hag Ito-2 <br />Telephone: gi _,/ 4 /0 <br />Program Element: 5 Program Rerord: cW bs-inc-?q/ Inspection Type: 4' <br />SB180 Posted Yes Permit Posted No Re-Inspection on or After: <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />0 gi-- Egg 0 vf ts • I I) .. *wk./ _ <br />C.0YK.wf tv <br />6 a4907 —cmvic bowa-a-abLe 100 no i ns Lax <br />-finA).e/ A g-pemw <br />1174-' yi4 oval POAfrtj w,f_o_k A-It 4-a, %52a rn‘war‘uy) <br />41/M2 -C <br />1 <br />0 citterufLe lest 5/yip /4(6,2y, Pc a d_., <br />v- Fad / <br />; to et.1) stcra 14,o1- cw / i / <br />1 c e, i 4 A h‘ig-c- att,q09 &ed_ <br />s / V CL-i 611 lei .e1-'1707 <br />hKe eAd 1 nyw Eaft&K t 4 b 6 ril 14 Vide ,5 <br />(9)Inte -ilitoderuo/tAbi-ey 1/4,(Airtg, prvvidJ__ <br />-iv (ss1A9 9 • 0 ov_. 9N,Lf Mi ce k t 0 is p&viml- ptnitd- <br />Item/Location Temperature 1 Item / Location Temperature <br />_g,e 165F xiiii4W___dor evgam „mc <br />Food Safe Certification Facility Hot Water Temperature Warewashing <br />Name: Hand Sink: .F Chlorine: ppm Heat: °F <br />Exp. Date: Warewashing Si k: . Ouat. Amm.: ppm Other: °F <br />Received By / Title: 4 4 c/ d A ( 4 .e,1;62‘f <br />EH Specialist: G <br />Phone:- <br /> i <br />i am <br />f le P I A ri <br />Time in: Time Out: Page of <br />EHD 16-24 (2", pg) 4/3/13 <br /> FOOD PROGRAM OIR CONTINUATION