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p..°...."'" SAN JOAQUIN COUNT <br /> O •.; C <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 186 East Hazeltoq Avenue, Stockton, CA 95205-6232 <br /> Te/ephon : (209) 468-3420 x: (209)464-0138 Web:www.siaov.org/ehd <br /> �iFoaa <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: C a' Date: 2- <br /> ddress: f! r City: Zip Code: <br /> Owner/Operator: C/n[e;kl� „/ ,e / Telephone: —6 r_ <br /> Program Element: / /��� Program Record: Inspection Type: >(� / <br /> B180 Posted 6 Gl ❑Yes ❑ Rermit Posted ❑Yes ❑1 Re-Inspection on or After:`�i <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> tl <br /> rJ/:)-a l� : . T A' R <br /> OF <br /> VY <br /> All- app6� Lf '3(' {'1'1 !2l/1�t/ <br /> CGtc,Q ( <br /> elw �o Le r�Riu ti " <br /> A <br /> r ` ai�a� toy 1084 <br /> 14t <br /> i- (A N <br /> -c-v', W4&i <br /> �Ua ofdAva <br /> IV ftla(G � <br /> emperat re Item t Location Temperature <br /> Food Safety Certification ��ty Hot Water Temperature Warewashing <br /> _ 4. _ <br /> Name: Hand Sink: of Chlorine: ppm Heat: oF <br /> Exp.Date: ar washing Sink: of Quat.Amm.: ppm Other: of <br /> Received By/Title: <br /> EH Specialist: Phone: <br /> ime in: /1 . Time Out: Page ofZ <br /> EHD 16-24(20°pg) 4/3113 FOOD PROGRAM OR CONTINUATION <br />