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�oP° .coG SAN JOAQUIN COUP'-'' <br /> Q` y� ENVIRONMENTAL HEALTH DErARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • c... :P• Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.slgov.org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: (W_ \0,"(AI ie ' \G1 Date: 12 /14 <br /> Address: rL 1 y � ,Mon+ City: Cl/Y-1-b I-) Zip Code: <br /> Owner/Operator: tt1 �(vtJe G / h G ov �1`ar Telephone: <br /> Program Element: 1 \\0 Program Record: 17 G 2 2 c�QI(� Inspection Type: b/1►�h� <br /> SB180 Posted YYes ❑ No Permit Posted es ❑ No Re-Inspection on or After: 2 w 12-t�S <br /> 1� <br /> 'Son-1 b U C W_* f0 SVfe 100 --V_ F Uv i Cke_ }vd <br /> wTt\ S 1-ti 1 IIU m Ivtr < ccwe <br /> ,+Weap to (.e pTO he.a+ <br /> CCo i na 1 &k Carte - <br /> 3 ObWVed W WAlinqc � Mdcar- -% &cmc -in Small m mars wotu+ <br /> A - S CAfi i2bc t . \A -f- J-6 Cir q" -j�lc.# <br /> QNe, " i ri- ond daboS (Al C A40T) WlGi` <br /> b SUMS✓ �0* 0Vz Cr W QA +Ww tum <br /> C/VCrN dU <br /> UbRir W Ck (On OF ++u wacew" <br /> 9 n 1z-- Priv e rd u ccnc"4v CA 1 csr Stun -4- <br /> 1 <br /> Item/Location TemperatureItem/Location Temperature <br /> G4e e"�e C(.L�_t 3 O`T Cnnk/d d-\i GWA_X 0Tt obs <br /> bS �5D` <br /> W M2q+ CCAo <br /> 12ef 1-?-i Vi 17Iz�dr- <br /> %? f 'F ')n 135`T <br /> Food Safe#fir Certification, Facility Hot Water Temperature Warewashing <br /> Name: rocio I�C¢ut-,- v Hand Sink: �LV of Chlorine: Val ppm Heat: of <br /> Exp.Date: 2 Warewashing Sink: 1�U of Duat.Amm.: ppm Other: of <br /> Received By/Title: � ,,✓✓ <br /> EH Specialist: Phone: ar, �`4(o <br /> Time in: 1 S- Time Out: V�` ;o O Page2_of2, <br /> EHD 16-24 (2nd pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />