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0P4"�" SAN .JOAQUIN COUP" <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> = 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax: (209) 464-0138 Web:www.siQov.orq/ehd <br /> FOR <br /> �� l� <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: U C/In �". 1 i au, Date: ID •2- <br /> Address: r N•1 s, i� ,� •� City: �^i -t�� Zip Code: 15 t <br /> ll'I .- `71 KJ <br /> Owner/Operator: btL 1 KCS Telephone: <br /> 1 P 'q -q }CI C3 <br /> Program Element: Program Record: h ��2 2 C��,2- Inspection Type: n oT) <br /> SB180 Posted Yes No Permit Posted Yes F No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> S t U (ACI S C C/f Te Ocd jaca V t <br /> 1 1 c.� SCo �n SG1�SGS r W� vn C c�rce�Ci <br /> " Cdr iu ICA \� ;Vz waS + <br /> i S ue s". e d . In SQu <br /> demNe <br /> Spit <br /> C;.,(.,cam fi SCO 1 <br /> ' -C)CA C Cn �� 16CQ I 1- CCAC4_-i, I CA e VTC <br /> Item/Location E temperature Item/Location Temperature <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: -F Chlorine: ppm Heat: 'F <br /> Exp.Date: Warewashing Sink: -F Ouat.Amm.: ppm Other: -F <br /> Received By/Title:' <br /> EH Specialist: Phone: r) O/7 r�ir_ <br /> Time in: Time Out: !I Pageof <br /> EHD 16-24 (2n°pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />