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SAN JOAQUIN COUNTY <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.orgiehd <br />'MI WE,' • • a •••• •••• • • • Mum • • mm ..m. • Eff . ..... ... ..... - - <br />Name of Facility: <br />1.( <br />Date: <br />tO <br />I 1 N-2_ 11 <br />li ./ICA.A <br />Zip Code: q ..-z S c, <br />Address: -3s 5 <br /> <br /> <br />1 1 <br />City: Silt/rAl/t <br />i 1 <br />Owner/Operator: e CV <br />al 1 <br />Telephone: <br />Program Element: 1 ° Program ecord: r i* 1 4C <br />Inspection Type: \ Ka-- <br />SB180 Posted Yes N • Permit Posted (Ce No Re-Inspection on or After: <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />)_' Pc c/ 9Ic) -Fly c4A,--vii(cRS' /leo/. <br />PN (Wu 4 pr,e-lociacoct !loll C , <br />‘e i nvreczii 01- Au oteloy we/A-utiY) <br />(AD l e--In19.-e ciwyl , <br />iSkiAe 20iS )202-014-71- 01(--e reytriAd- <br />--- (c r,---, <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 />Quat. Amm.: ppm Other: °F Exp. Date: Warewashing Sink: o F <br />By / Ti ) tleX' c.x.Vi Rece <br />Specialist: <br />' <br />ived <br />EH Phone: b ,C4 LE) <br />Time in: Time Out: Page of <br />EHD 16-24 (2^d pg) 4/3/13 <br /> FOOD PROGRAM OIR CONTINUATION <br />R osul ?.0)