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SAN JOAQUIN COUN. <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 />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />Name of Facility: (.1 k e• <br /> <br />r Lc' ster,sso cw-, r,,e.o...— w. IA IC- VI c‘170- <br />Date: <br />Address: -5,50 iv City: siv4.40.1 Zip Code: <br /> <br />x"14704 ViOa <br />Owner/Operator: Telephone: <br />171$1 i)101:.(AA 661 <br />Program Element: Program Record!) 0%-AI:sten Inspection Type: ce / <br />SB180 Posted e No Permit Posted es No Re-Inspection on or After: <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />1. 1 4 _ infrAt Si Ceviq oftl . <br />_ <br />cv, 5,k, <br />- av.ait.1,,a,1 <br />- tvit.T_ v.obt,,k) s.; te. -_ tw 'F- <br />- (otA tv. ' i', &et, &A DA 0 v4....- (Ario la waver rk <br />\Zoe \k‘L\pi - <br />oic- Ap 6i:iv& ,11,( lc A 44.5 tvaArt- \Gm, o' <br />Item/Location Temperature Item / Location Temperature <br />Food Safety Certification Facility Hot Water Temperature Warewashing <br />Name: Hand Sink:o F Chlorine: PPm Heat: °F <br />Exp. Date: Warewashing Sink: mo of.- 0 Quat. Amm.: PPm Other: °F <br />Received By / Title: <br />EH Specialist: - <br />-C•K.A''r,Ck—"'---------- <br />Phone: <br />Time in: .... .-, Time Out: ,..,..1/41 ‘,1 <br />n• ,0 a," , ‘ Cl%M. <br />Page of <br />EHD 16-24 (2,4 pg) 4/3/13 <br /> FOOD PROGRAM OIR CONTINUATION