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IV SAN .10AQUIN COUP <br /> _ y 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 /> .0/FOR <br /> l 1-4- }, FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: C 0cuzrn -} y- r�_ 51 �t�U�Z1t�- Date: 21 <br /> Address: ) L c-' . l v'U I Il s'; �3 City: ,p.4�_C� f-1 Zip Code: C''1 ��2 <br /> Owner/Operator: NWci h3on 1 enc J1 1 Telephone: r` uC)1`�9 <br /> Program Element: tOcL Program Record: �h u o } 149 <br /> I Inspection Type: c—�Gn <br /> B180 Posted ❑Yes ❑ Permit Posted I� ❑Yes E I"1 r Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> %41 <br /> ,kin no-� it ern <br /> 5'xe' j in <br /> TIZO c4_ in c c\c <br /> od -t -u izA r CP 1 ee_S r n <br /> f�G G G S <br /> ftertt»ocation Temperature Item J Location Temperature <br /> -- _ <br /> rd <br /> Facility Hot Water TemperatuV re,�� Warewashir+g <br /> .-� PPm _ <br /> Name: Hand Sink: Chlorine: !Heat of <br /> Exp. Date: Warewashing Sisk: i Z(� 'F uat.Amm.: PPm Other: of <br /> 1� <br /> Received By/Title: _ <br /> EH Specialist: Phone: 11-t <br /> t cry _ j <br /> Time in: rl ; Time Out: `10 ,110, 1Page lof / <br /> EHD 16-24(211pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />