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SAN JOAQUIN COUN <br /> a Z+ ENVIRONMENTAL HEALTH DEPARTMENT <br /> - _ 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax:(209)464-0138 Web:www.sigov.org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: 'V- rC \A� Date: -3 <br /> Address: -7 v4 1 r c e City: S Zip Code: 'e 5-2-c7 <br /> Owner/Operator: 7_ -5 kX Q H Y 0, Telephone: <br /> Program Element: + C3 tJ Program Record—. (_,,, 0 3Cl 3 Inspection Type: C� <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> , , OBSERVATK3NS AND CORRECTIVE ACTIONS <br /> A, a, �- S S 'qoa(Zj,eS L,-.32r-R- - <br /> 3-IB <br /> e_,�.Ankrol +o csaL�t�1_(�ec^� C1C �iVt���. _ <br /> /Zo <br /> cLc<4 ' 4 c>6se r e j_ �• rc c e <br /> --- <br /> C CKCS r CU rt-� cx t <br /> w <br /> CL-C- <br /> AJ Q Qrac 6 4s-�(',, o t sS v cJ— h �2 <br /> t"l c'ur5 Q ne <br /> C:oo �� / <br /> I l`> (es <br /> itemlLocation dem erature Item/Location - Temperature <br /> ��� p <br /> I <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: F Chlorine: 57E:) ppm LHeat: `F <br /> Exp.Date: arewashing Sink: � of Quat.Amm.: ppm `F <br /> Received By Title:, <br /> EH Specialist: n \ Phone: <br /> w -- --.-.....- -- --- <br /> Time in: r 0 Time Out: , 6 Page' of, <br /> EHD 16.24 (2nd pg) 413113 FOOD PROGRAM OR CONTINJATION <br />