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IT SAN JOAQUIN COL Y <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazeiton Avenue, Stockton, CA 95205-6232 <br /> • �q ,.•• ..•,p• Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.siaov.orcLlehd <br /> FOOD PROGRAM OFFICIAL INSPECTION DEPORT <br /> Name of Facility: 1;On-I UY- CAVya(02 s Vel Date: � <br /> Address: �a -S �r CX— City. � ' zip code: <br /> Owner/Operator: �1` [1Un Telephone: <br /> Program Element: ,f _�j Program Record: VV U 5(Y) Inspection Type: <br /> S6180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS` , <br /> W &L& W <br /> - n i S Ut i l ei-12 F . "ana SzkKS <br /> ev-, 1 -1 <br /> Ins 1 am <br /> y-u n moI . cm <br /> Cyr n c) . d t A-Z> 1 6T car ; A-b d <br /> r\SLe <br /> ovr r� <br /> -D <br /> Lcd f QM h VA i <br /> �.lU�LS <br /> 10Vt -N- [ 02- O25F <br /> 4 + d oeS CA OT G-�er �. a <br /> MRI <br /> \1 war M CM fibz +. <br /> IU a e <br /> S O 'b� �t S cmtnj RdA cl <br /> CAA �0 "i of- n <br /> itemlLoca n Temperature Item!Location Temperature <br /> E <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: 'F Chlorine: ppm Heat: `F <br /> Exp.Date: Warewashing Sink: F Quat, Amm.: PPm iOther: °F <br /> Received By 1 Title: <br /> EH Specialist: Phone: <br /> Time in: 5 Time Out: ��!kx-- <br /> LJ Page off <br /> EHD 16-24 (2n1 pg) 4IN13 FOOD PROGRAM OIR CONTINUATION <br />