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oP411y 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.sigov.org/ehd <br /> <<FOR • <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: r,(2 vAS co nrA Date: q-'';5/ <br /> Address: '20-6S j o,Z4C City: Zip Code: q� <br /> C -?- <br /> Owner/Operator: V ('k hCv- L <br /> Telephone:l.r — (0 <br /> Program Element: C Program Record: Inspection Type:,(G <br /> SB180 Posted Yes D No Permit Posted Yes i No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> CCS I n t Cit I Yro } p._ <br /> 1 � h <br /> Q61iiNA GIS CA n ( - C1 CA 1 CJ kN 1 a'f-Z Th Q_ <br /> AaRp <br /> - <br /> -- kc t i <br /> Ali <br /> Q cl . Cu"Ra Gil GM-1 I R 0 vlU baye, g�-- <br /> vh a SeJm Ot) , Qrf(kW(fi K4m ii nS 4qq <br /> G1nd ve olo- <br /> (Q�T <br /> i <br /> Item/Location T-- Temperature Item l Location Temperature <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: of Chlorine: ppm Heat: of <br /> Exp.Date: Warewas 'ng Sink: of Quat.Amm.: ppm Other: of <br /> Received By/Title. -_ <br /> EH Specialist: Phone: <br /> ime in: I Time Out: 1 ; pJ� Pagel of <br /> HD16-24 (2n'pg) 4/3/13 \ FOOD PROGRAM ORCO Pagel <br />