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City: <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />a <br />^Vroiri <2 H (g ITI'IJL- <br />Y\cA\jQr p) O -V <br />bocH-/? <br />I cbje) <br />Name:Heat: <br />Exp. Date:Quat. Amm.:Other:°F °Fppm <br />Phone: <br />I <br />Warewashing <br />ppm <br />■ <br />CF <br />Ho 4 cU <br />Food Safe <br />Name of Facility: <br />Address: <br />K-P g >•'1—< rX C <br />(D Y\JL <br />CjL'tyX^Y'_______ <br />P *>5 3 7 1^ 7 <br />Yes No <br />i p s <br />Temperature <br />ai°F <br />s <br />e> K <br />Owner/Operator: <br />Program Element: <br />SB180 Posted Yes <br />- ■ ... <br />/p) \) )c+ori6? <br />-i2z>a <br />Or lo^ <br />cP p^iV- <br />__~ 'P ro iH <br />___b *' c.li A <br />Item/Location <br />TilhU.____ <br />X ObCe r______ <br />St'VX ___ <br />s <br />Certification <br />Temperature ; <br />TbsTI <br />I3SH <br />3/T J <br />Facility Hot Water Temperature <br />Hand Sink: Op <br />Warewashing Sink: <br />San Joaquin Col y <br />ENViRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.siaov.org/ehd <br />____Q <br />Received By / Title: \_/ <br />Tll"ein:/ <br />EHD 16-24 (2nd pg) 4/3/13 <br />Food Program Official Inspection Report <br />rodiv'Al__________________________Date: <br />c+on ZipCode: <br />Telephone: <br />Inspection Type;--^^ <br />Re-Inspection on or After: <br />~(t> o r <s ick <br />LU l >3 cl^cuL <br />Item / Location <br />b ■ YT Lc Y"___ <br />6Tt>cX ton "Pr> <Lc <br />7X i M C-€ n-tr* r 4a <br />A>4~o c) Abo n i <A-g- <br />Program Record: <br />No Permit Posted <br />PageNet <br />FOOD PROGRAM 0IR CONTINUATION <br />SrB^y <br />^63-0817 <br />Time Out: H HQ <br />Chlorine: