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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.org/ehd <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />- i/4- .? _.-,_ Date: C.1 ...)_Li Name of Facility: ,SCU/ c..A0alLttil C OA h. e a Va12-lite ailk <br />Address: Ltcr. Pete -et c., PW-e- <br />City: ci-celcInr\J Zip Code: ?M... <br />Owner/Operator: <br />0 c5 D 1-0-KA- <br />Telephone: -7 -4 _---ici 6 -)_. <br />Program Element b ± Program Record: ip eintso. ,i.. pzbi ObeitiOnspection Type: nP 1-1:10 <br />SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br />-, <br />1 <br />. CQ - <br />al nlilget_aknD'tt. vtil eilAttCe <br />g A16Qin irDs AimonA <br />it 01(4- pK_er lot( 4( _e .:-' .__-1 .i"-1/111--19 Los. <br />6) DiopetInim ',/tv-fim- prtA LIP <br />5o 1(560, 1.09 <br />CA -WO prir ir\-s- 00 P <br />Arel -- til,C1 -L(-- <br />Item/Location Temperature Item / Location Temperature <br />Food Safety Certification Facility Hot Water Temperature Warewashing <br />Name: Hand Sink: o F <br />Sink: o F <br />Chlorine: PPm <br />PP m <br />Heat: 0 <br />Exp. Date: Warewashing Quat. Amm.: Other: . <br />Received By! Titlg- <br />EH Specialist: <br />a•te14- <br />Phone: <br />IQ* ' 3t -10 <br />Time in: 0 aro Time Out: Pag4of 4_ <br />EHD 16-24 (2^, pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION