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SAN JOAQUIN CO TY <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 /> �%FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: !k�F-r cA4z(- 0.1-4 Date: C 12_(j': ,_ <br /> Address: 1 C(CX <br /> le CA-0 b 61T `-J City: �1 Zip Code: G.>3/_ <br /> Owner/Operator: .1 P-, nJ Moe-<- r1/1 Telephone: W <br /> Pam' a�i cT1 2-13-+q <br /> Program Element: i tO Qs Program Record: FF,652 ��b3 Inspection Type: <br /> SB180 Posted Yes 1 MNo�t Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVAT€CNS AND CORRECTIVE ACTIONS <br /> fJS Ise \K�- - - <br /> Li und <br /> c <br /> (___j)2aCq, CGM Mun- <br /> N6 WaZM \%fGqef- v S did' - CGffe <br /> >Otr uacvS vAcAV-/ - 4;�a 'i0acK <br /> \�. tz SOGL W-Aef- M � <br /> cif W42&W cwn - coe <br /> cn 1-ha-ok -- - <br /> 1 11 T <br /> ►vo y �►e r a "zi w f iy' 3 . aKe _ - <br /> Item/Location i Temperatu Item 1 Location je:rrperal e <br /> Food Safety Certification Fac ii �#ui �erature <br /> ; P Warewashing <br /> Name: ;,Hand Sink: of Chlorine: ppm !Heat: of <br /> I -- -. I- <br /> Exp.Date: NVarewashing Sink: of Quat. Amm.: ppm Other: of <br /> Received By/Title: <br /> EH Specialist: LU Phone: <br /> Time in: Time Out: v Page fQ <br /> EHD 16-24 (21a pg) 4.'3/13 FOOD PROGRAM OR CONTINUATION <br />