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SAN JOAOUIN COUP <br /> P <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 4: .a <br /> - _ 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.s4gov.org/ehd <br /> <<Foaa <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: C O&A, Cl Ct U Date: <br /> Address: 9t-?>—+ <br /> City: --DCT--vp Zip Code: C1 <br /> Owner/Operator: QCA Telephone:; SI _3Zv9 <br /> � <br /> Program Element: l .i Pr ram Record: ] v95C 1)) `S Inspection Type: (f�_ <br /> SB180 Posted Yes No �t ermit Posted Yes No Re-Inspection on or After: <br /> __. <br /> C?BSER3/ATI{7NSAND C©RFt CTIVE_14C'17ONS <br /> ------------------- <br /> crN <br /> �- jc�t i�s 2vhc�n fi U v rrP�n a 1 �� <br /> �o-\- U vJ tcfi-�Lv ia <br /> ah `s5v,-e, -1�Mm I j tr,-iS <br /> Item/Location _I Temperature Item/Location Temperature <br /> ................... --------- --.._.. ---- -----. _ <br /> i <br /> I <br /> ---_ ...... _ <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: °F Chlorine: ppm Heat: `F <br /> Exp.Date: Warewashing Sink: of Quat.Amm.: ppm Other: of <br /> Received By/Title: <br /> EH Specialist: Phone: (01D -'6A/�O <br /> Time in: fiTime Out: lo -.(.) o Page of <br /> EHD 16-24 (2n0 pg) 4/3113 FOOD PROGRAM OIR CONTINUATION <br />