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SAN JOAQUIN COUN'TY
<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.orWehd
<br />FOOD PROGRAM OFFICIAL INSPECTION REPORT
<br />Name of Facility: 1.1< C.c. C Date: 02 _ ki —I g
<br />Address: ‘3.C.Co Pi) iAl Lam. (A) ial
<br />City: .
<br />S hi) th- frri Zip Code:
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<br />Owner/Operator: K iwi Ph a ,, yi,
<br />Telephone: a, ,s er) Kilq. .11.2.,
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<br />Program Element: Program Record: 2.6 Pg 0 c0 I.1 -1-ii
<br />Inspection Type: 14
<br />SB180 Posted Yes ci.:c.) Permit Posted Yes Re-Inspection on or After:
<br />OBSERVATIONS AND CORRECTIVE ACTIONS
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<br />Item/Location Temperature Item / Location Temperature
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<br />Food Safety Certification Facility Hot Water Temperature Warewashing
<br />Name: i< - ii , , - .
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<br />t It
<br />Hand Sink: o F
<br />( 2 ci' Chlorine: (.. PPm
<br />Heat: c.
<br />11/104 thi.,,,,,,,,,
<br />Exp. Date: 20 i g
<br />Warewashing Sink: / 30 .F Quat. Amm.: ppm Other: .
<br />Received By / Title.
<br />—C(--C,Cic
<br />EH Specialist: Phone: 45 -3 6917 RI
<br />1
<br />Time in: Time Out: Page of
<br />EHD 16-24 (2nd pg) 4/3/13
<br /> FOOD PROGRAM OIR CONTINUATION
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