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110) SAN JOAQUIN CCII. <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East HazeIton Avenue, Stockton, CA 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.siclov.orq/ehd <br />4-f- .0 <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />Name of Facility:f.--::eamoiw, IA 14. i, 0 Li .4,, _. 2... Date: e2 .._ 0 3 _./g . <br />Address: '3-1 1-- S UlA i'CIA 1- . <br />City: Zip Code: <br />t S--2 /. 1 a 3 1•::.c k 1 - t‘ , <br />Owner/Operator: -R-014.1.c.- C-::. C -,/ re -5 e--... • Telephone9 09 4748,7 <br />-'-' Program Element: /6 Program Record:'" /7 A, 0 3 )--q-4, I Inspection Type: 1 <br />SB180 Posted Yes No Permit Posted Yes No c 4. c c 4(,:qg Re-Inspection on or After: <br />,...-- <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />' Let -v-4 ii7--, ‘i--, S- ir4- te--"J ..-1-- e.-1- I GA cdf-z_171,- <br />(- <br />0 6 5 ekv-e-e7 ZbrI e 'Ve--- (4 ( , * di& iorNi/ ' <br />di rr C-1,24.47/z. 6' c IXti..,.5 0\A Si '/;" l'Oei..! <br />CAC"(frL 1 5 a ti c,t.ti-eassf St,6 <br />20 aip__Se9 Ley( q 7 4- / c , .4,_ -i-e----ri 1% e ...- ata i .e, <br />4 /Foy hi-P 4914-) <br />Item/Location Temperature Item / Location Temperature <br />Food Safety Certification Facility Hot Water Temperature Warewashing <br />Name: Hand Sink: .F Chlorine: ppm Heat: °F <br />Exp. Date: Warewashing Sink: . Quat. Amm.: ppm Other: °F <br />Received By / Title: <br /> <br />EH Specialist: 6 ,,i- Phone: /tag 1 5 - 3 .-7/-erg---- <br />Time in: <br />/ / <br />Time Out: Page of <br />a9 ; 5- <br />EHD 16-24 (2nd pg) 4/3/13 <br /> FOOD PROGRAM OIR CONTINUATION