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SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />Q: a <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />cq.; = gip. • Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sigov.org/ehd <br />ciFoa� <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />Name of Facility: <br />C,, -Le do C • h Date: , _, -�'- <br />Address: 1 S� 1 <br />-G3r city: Zip Code: G <br />OwnerlOperator:Q <br />W ; Telephone: Si0_ -7 _$S <br />Program Element: \ `U 1 ..2 Program Record: S' 1 Inspection Type: <br />B180 Posted []Yes 0 Rermit Posted ❑ Yes n 1 Re -Inspection on or After: <br />OBSERVATIONS AND CORRECTIVE ACTIONS ., <br />\ P <br />1�Q Goc r <br />P -� � �• -� .� <br />� <br />e <br />r <br />4 <br />are <br />r -3025 sn IQ <br />CA <br />.9z $ <br />(' <br />1-\-C h F <br />2 'r - <br />A\, —.\( -5 <br />C <br />k2 -C) 3qF_ <br />I <br />-„ Item/Location _ __s: .... Temperature �I _ Item}Location ature_ <br />1149 F A prep 1, <br />;•- Certification '.Facility Hof Water Temperature Warewashing <br />Name: --' Hand Sink: F Chlorine: .`�vppm Heat F <br />Exp. Data: <br />Warewashing Sink: ,2 'F <br />uat Am m.: ppm <br />ther: `F <br />Received By / Title: <br />EH Special' <br />1 u' L <br />Phone: <br />JPage <br />'me in: I,\'.2_5 q <br />Time Out: of <br />=k] <br />EHD 1824 (2n0 pg) 4013 FOOD PROGRAM OIR CONTINUATION <br />s9 <br />I <br />M <br />