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SAN JOAQUIN COUt <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East HazeIton Avenue, Stockton, CA 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sigov.orq/ehd <br />c1C) <br /> <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />Name of Facility:1--1/4..` ,--yeb I -e P 4---14' CC-V r‘ Date: nt----\ t--.A <br />Zip Code: ot s-a1/4.4 0 ..A....x..ii, Address: -czcs City: v--. _vol. r_sA. <br />Owner/Operator: <br /> <br />Telephone: bk 0 _ 0400B <br />Program Element: \%.0,3 / Program Record: s ..A I -2,--1 9 Inspection Type: <br />SB180 Posted 0 Yes 0 Rermit Posted 0 Yes or Re-Inspection on or After: <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />\-•...-L; ,..i.,26--\..*- \., — , <br />\ <br />5 . " \ <br />(3‘,. <br />OV-- --1c-2. fiQ„.....„4....4 fo/ 2-ot b <br />— ea.Acil <br />N ), -.)‘„-)lc—Itat--i.,2_ <br />Oz-2_, <br />ct'S- 22. <br />Item Location _ <br />\ IZ --c-("-v-- <br />Temperature Item / Location Temperature <br />(:),t-rN <br />Food Safety Certification Facility Hot Water Temperature , - Hand Sink: \ 1/4...., <br />oF <br />VVarewashing _ <br />Heat: Name: L.04_1......t <br /> 0 c-c3-2* Chlorine: ppm 0 <br />Exp. Date: ‘ (?) '..2-02-., <br />Warewashing Sink: - °F Quat. Amm.: ppm Other: o <br />Received By / Title: <br />EH Specialist: <br /> <br />... Phone: y - 68-03 Time in: c-, 7 ...v.) Time Out: s s 0 of <br />0 VIC\ <br />Page <br />EHD 16-24 (2^d pg) 4/3/13 <br />FOOD PROGRAM OIR CONTINUATION