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oR�ui" SAN JOAQUIN COUNTY <br /> yX ENVIRONMENTAL HEALTH DEPARTMENT <br /> J. 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> �q.. 9•..•�P Telephone: (209)468-3420 Fax: (209)464-0138 Web:www.sigov.org/ehd <br /> i <br /> Lg <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: V',C Date: II C p� <br /> Address: , City:4L' '�^ Zip Code: Z/ <br /> Owner/Operator: C-1LA <br /> __ Telephone: <br /> Program Element: b Program Record: n r\��+-LkA'A{� Inspection Type: t <br /> SB180 Posted Yes o Permit Posted a No Lr Re-Inspection on or After: <br /> BSERVATIONS AND CORRECTIVE ACTIONS i <br /> • l,�c, � v L <br /> S u IQ AAnNh <br /> VAAw, ' s I I "a <br /> 7� Twilli, Lot h D i ?,` co <br /> • �,,`i � <br /> Item/Location Temperature Item/Location Temperature <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: of Chlorine: ppm Heat: of <br /> Exp.Date: arewashing Sink: of Quat.Amm.: ppm Other: of <br /> Received By/Title: U� / •-e _ J -- <br /> EH Specialist: ! Phone: <br /> Time in: Time Out: Page of . <br /> EHD 16-24 (2nd pg) 413/13 FOOD PROGRAM OIR CONTINUATION <br />