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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.sigov.orgiehd <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />Name of Facility: \ ( -VA( t aC--)cro a 1; Date: 1.4, 1 Da 1 -3...K1 <br />ddress: 5 City: 3-t-LyliCNI Zip Code: qS-DOS N <br />Owner/Operator: <br />On 7:al f aJtAct. Telephone: ' <br />Program Element: Progra ecord: <br />IQ OC t01004 <br />Inspection Type: 12_00-Deul...) <br />SB180 Posted Permit Posted Yes No Re-Inspection on or After: <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />* \26k }V D 9SeAV 0 A I Pio V I 1 16taiiig0 1'19 <br />9)701 1 cevil, nS oferl i ov <br />6,ek7i, oi <br />6)A.,411A..Q LAI wectim n D aur vt, <br />VP' 0 (47 e-Or trn ' <br />Item/Location Temperature Item / Location Temperature <br />Food Safety Certification Facility Hot Water Temperature VIlarewashing <br />Name: Hand Sink: .F Chlorine: ppm Heat: °F <br />Exp. Date: Warewashing Sink: . Quat. Amm.: ppm Other: °F <br />Received By / Title: Ze Y70/(/ 0/cf c.:;6%/irac7z- <br />EH Specialist: Phone: 2f'\4 ao -3 Ol-klo CM r-2.40a/K- MA <br />Time in: <br />• <br />1 ,_ 4 CA fyi Time Out: 3 (, DO " ON Paget of / <br />EHD 16-24 (2^, pg) 4/3/13 <br /> FOOD PROGRAM OIR CONTINUATION <br />PousLiccooLl