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SAN JOAQUIN CO� TY <br /> ?+ ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • �q. a;P.. Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.s'gov.org/ehd <br /> �I FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Q1 Ci GInu Date: C6 <br /> Address: 3G <br /> t-,. w�1 OU City Zip Code: <br /> Owner/Operator: \JeA—�n (_4-mh <br /> Telephone: e321 _ 'W--�2- <br /> Program <br /> Program Element: Program Record: of b 1C 31 C O Gv 4 C�j Alnspection Type: <br /> SB180 Posted Yes No Permit Posted Yes No Re-inspection on or After: W <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> (TM W1 fA_ St0Aes: fi I P_A S r�SiG� fir✓ <br /> - U L vi - <br /> h t4' i(-, Ci r00-f- l QC �- a�_-oN e, 11%e- TUt o <br /> coc)U/c 'c a .h jr) ryve nd ccO) veA , zz�fi�rm <br /> TtAa 0VqXX tv nom �r FiX <br /> uDbk \.ec��s. e rr bust- rv�f S n <br /> trAA QCeU nk weir C6 u a A;'LA�\ . <br /> 4- 'i;-i xc <br /> Item/Location Temperature Item!Location Temperature <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> — — <br /> Name: Hand Sink: of Chlorine: ppm Heat: of <br /> Exp.Date: Warewashing Sink: aF Ouat.Amm.: ppm Other. 'F <br /> Received By/Title: i <br /> EH Specialist: Phone: !Z()C,� G� _ <br /> Time in: U` Time Out: �lJ`;��� V Page rof <br /> EHD 16-24 (2ntl pg) 4/3/13 FOOD PROGRAM OF CONTINUATION <br />