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SAN JOAQUIN COUI <br /> ?< ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax: (209)464-0138 Web:www.s*gov.org/ehd <br /> ��FORI� <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: , due Date: a,-1 7_15 <br /> Address: y 5 01 City: S_lTotom-yt Zip Code: 6)5-:2-0 <br /> 7 <br /> Owner/Operator: -Fp <br /> `-00 d d LA )L CYT Gv Telephone: 95 1- <br /> 67 5 <br /> Program Element: 10 1-1 Program Record: P R (D Oe03(4 Inspection Type: �_j4IYu <br /> B180 Posted - Yes Permit Posted Yes ❑ I Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> n d 5 LSc'4 t.v ei r 1'(105 SkU.L+- L-)f- LaaAL <br /> b <br /> 70 P el L( b <br /> 01 Ll n r b 1 4 cA <br /> Vj a Lt Vae kivnr­l <br /> A n C,Lv a r l - too r .l -ac- <br /> C VtSi -I Vt-' I C, LDP, 6t, 1 GU'Lr "L <br /> aQ OL. (Ah Le.- at.♦ -b o r-eA o V-1 <br /> V_ ra 6o14-(-4e_ Lm rr-e C1�._r'o��l-er <br /> No 6R, -,L-GvYn-D r*9r4-C y7 Yt 0 +- au oL-; (A*, Lt— P no V'I <br /> a-i <br /> _ ,a,„., ,,Temperature Item 1 location Temperature <br /> oreel <br /> 'y` ((o ooF <br /> r ns '4l° kn 90T <br /> -- -- <br /> ChiU14 <br /> Food Safety Certification j Facility Hot Water Temperature Warewashing <br /> - _ . <br /> ( I Hand Sink: /�.. Chlo ng !Heat <br /> ame: 14anr✓ h�!✓Jer t CJhGI 1 ��J i F _ Ly644 CA-OL-12 PPm F <br /> Exp.Date: _ ewg Sink: of Quat.Amm.: ppm Other: of <br /> I <br /> eceived By/Title: <br /> H Specialist: Phone: L- <br /> ime in: t t Time Out: LID <br /> Pagel! Z <br /> EHD 16-24 (2w pg) 413/1-31 _G V FOOD PROGRAM OR CONTINUATION <br />