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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.siqov.org/ehd <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />Name of Facility: CV Oki (,) c i )71, au q) Date: Lt4, Ms_LI- <br />Address: City:,,,,,,,,, Zip Code: a ,r jor,,,,,,,,,,l, Telephone: Owner/Opfelator: ju Co wir.,,,b <br />Program Element: i Lr_ Progr'airdiecord: 5,3 )1 ...9, Inspection Type: R00-t ruL, <br />SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br />._ <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />'-D VAC v P-z-S <br />4-DIA--A\ n m Oc& 11,.e0M-i--Cwp --E ) :01htd-- <br />)4s-pcca soligu 31cfsn. <br />Rovo-tru_ vicl9e0-1.o•n- nO nvt/or vrtelecL-H-Le-k. <br />\(\) (e---nw p_c--Ic3. <br />Item/Location Temperature Item / Location I Temperature <br />Food Safety Certification Facility Hot Water Temperature Warewashing <br />Name: Hand Sink: .F Chlorine:Heat: PPm "F <br />Exp. Date: Warewashing Sink: . Quat. Amm.: ppm Other: °F <br />Received By / Title: 1 Ci- j\r \r\ t rVi,_ <br />EH Specialist: -1) iN Phone: —(01 6-3046 <br />Time in: , ( i (try) Time Out: ----- : 1 to a hl Page ( ofl <br />EHD 16-24 (2'd pg) 4/3/13 <br />Pk OS 38 I