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SAN JOAQUIN COUNTY
<br />ENVIRONMENTAL HEALTH DEPARTMENT
<br />1868 East HazeIton Avenue, Stockton, CA 95205-6232
<br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd
<br />FOOD PROGRAM OFFICIAL INSPECTION REPORT
<br />Name of Facility: Ca..444. (IA ivk fie,( Date: U/Z.Vici
<br />ddress: (06 cz_ vs t..6 0,,A 1 ir, pre, City: Oetie42,4". Zip Code: Ci5---ztici
<br />Owner/Operator: AA, i? p
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<br />PW1P (..el vi-voq TI*1/Yein C4-- AA:fiCrk
<br />Telephone:
<br />Program Element: I & 0 Program Record: riz_04-yticrst., Inspection Type:
<br />SB180 Posted Yes Permit Posted es No Re-Inspection on or After:
<br />BSERVATIONS AND CORRECTIVE ACTIONS
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<br />OIC 44) (..f.,ipe_. cAss.4., •grecA, kA4v•c.., -,C,%,‘
<br />Item/Location Temperature Item / Location Temperature
<br />Food Safety Ce fication „4,..fasfifttiot Water Temperature Warewashing ____Aawgicialaisia
<br />Heat: °F Name: Hand Sink: .F Chlorine: ppm
<br />Exp. Date: rarewashing Sink: °F Quat. Amm.: ppm Other: °F
<br />Received By / Title: \
<br />EH Specialist: Z i\ Phone: 10ey (A V h _
<br />Time in: Time Out: Page of
<br />END 16-24 (2nd pg) 4/3/13
<br />FOOD PROGRAM OIR CONTINUATION
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