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SAN JOAQUIN COUNID <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 />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />Name of Facility: <br />Cl- -P <br />C Op N.' .N...S_) LF K uki ci , (,-- <br />Address: -5----CD Iv , 11A) ' Iso-7/1 City: Zip Code: <br />Owner/Operator: Telephone: 33304 <br />Program Element: // Program Record: t„...,_.› P k7 '4'9 05-oL1--1-7 5— Inspection Type: lic, V+1"tk.SL <br />SB180 Posted /Res 0 Permit Posted es 0 I Re-Inspection on or After: <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />1 C <br />0 /VP —r690 ---- ka_.,Ad_te_r",s c r-ci -Ay YU_ IA) i CI <br />1:) 10 v; cLe n .... <br />Y -.5 <br />0 /6- 1 s5 t,u2 2_0 i le ryrit.' cit <br />1.s pa -- l_ A._, <br />Item/Location <br />S 1 I e r __'i r_ <br />Temperature Item 1 Location Temperature <br />Food Safety Certification' <br />Hand Sink: <br />Facility Hot Water Temperature <br />i Lo .F <br />Warewashing <br />PPm Chlorine: Heat. 0 Name: kj- 1111)0,L5 1 difrp 0 '1 <br />/ Exp. Date: <br />/ 2c, 1 - arewashing Sink: / ZO .F Quat. Amm.: ppm Other: . <br />Received By! Title: / <br />EH Specialist: <br />AP 0 Phone: <br />. tA)CYX.42) • ___.., Time in: 7 I-kr Time Out: <br />Cli 0 <br />Page of <br />EHD 16-24 (2^d pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION