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SAN JOAQUIN COW <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East HazeIton Avenue, Stockton, CA 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.s.gov.org/ehd <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />Name of Facility: lb ul C 62, cAr.eci NA 4.(c, N -t -1,1c Date: <br />Address: e'e't1 Ca r parledi Icl City: %tvoick_an Zip Code: q .2.1C <br />Owner/Operator: /I NcA 1 1 StAi C4 Telephone: Ct 92- 2_146 <br />Program Element: <br />1 k,9 4 V2. 0 cb 2 c-..) GI c.1 tz wai rt.t. Program RecodC -_,.5 Inspection Type: <br />SB180 Posted Yes No Permit Poste Yes No Re-Inspection on or After: , <br />J <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />0.) lag own0A 's iy)n-le Go- v)c),-v- INI C 7rJTh \Cii-e S <br />c)-• N -ON Oa - <br />OV AZi le, tTNYV +Of 0.1)\c- <br />-- _ <br />Item/Location <br />- <br />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: . Ouat. Amm.:°F ppm Other: <br />Received By / Title: <br />EH Specialist: IN, Phone: g_ 00 ..- 4_ bt ._3 4 4_ k=:, <br />Time in: C6 - --,D Time Out: 2) .. 4_ 0 Page of <br />END 16-24 (2^4 pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION