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SAN JOAQUIN COL <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East HazeIton Avenue, Stockton, CA 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.siqov.orq/ehd <br /> <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />Name of Facility: F 1 Alia -1-1 *...- Date: i 2_2-1 .ao <br />Address: --1 -b40 5 . (-4.4:xti _Forru05\., City: 6.1.0 c_icrfor) Zip Code: 00'2-0(4 <br />Owner/Operator: <br />(4u. rtry,.... 61u2-n-Lctrl Telephone: os 2_526:5 <br />Program Element: 400..3 i No Irrogram Record: (2_ DO r7603 6 0 Inspection Type: eons° titx+i-o„, <br />SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />1 i- 1 I 2) L its' l ,c-- <br />U LA I tA ciEL,11 2 -ZSCA 151o14 <br />5 0 yuL'o, au ex.1 La-to Liz_ .1.,r1 <br />p V't til 614-8. 1.,3 'GO rrl LA ccorrh) <br />an rtr,e (4-- 4--k-t OD LL.oLdt I-1 ..- <br />c-.) net.t_ CA ( -e --e nh414-.1.- VLOk-It 5 . -P--epc(2,..y- / 1-2-epLat <br />(s) --"P To Oi 8.12_ D It ,Ar' --‘'D vuz.ei +TV (I-. LAJtAU f <br />CD --"PC,s+ 6T5 Mtkl , u_A-‹ nst I ,,s‘ <el .00--) RonALAict-sh , <br />0 _ K. -A-e, G5su-e- r r"....kA <br />T r0 deVreN Yln tki3-.6 <br />Item/Location -- - F-Temperature Item / Location <br />-2- a-00 v" p r--ep Yier <br />1 3,00, s•C 7.--,(1-4 --t.._ 2) 2°R I <br />64e 01 yn -1-co9 I e 166 <br />Food Safety Certification r Facility Hot Water Temperature Warewashing <br />Name: Ltakotar.ta... blu.-Loict r? Hand Sink: <br />I 240 oF Chlorine: PPm Heat: `F <br />Exp. Date: -2.-.— 1 (40 -"-2-CI Warewashing Sink: 1 zo CF Duet. Amm.: <br />PPin <br />Other: CF I <br />Received By / Title: / ' <br />3 eeii/ Z-3 3 -L7 Sk 4 3 EH Specialist: 1-7 <br />Time in: F:4 6 Time Out: of : 30 Pagel of 1 <br />FOOD PROGRAM OIR CONTINUATION EHD 16-24 (2nd pg) 4/3/13