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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.org/ehd <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />Name of Facility: n U LC E5 /14,Sgi 09 46 . <br />Address: „4::rj=x6==ifie Rs 40 syciAio cuwee: <br />Date: /WQL/ <br />sive, Zip Code: <br />103- <br />Owner/Operator: Telephone: <br />Program Element: j 4(3 Program Record: "1 <br />6/ 9/ <br />Inspection Type: <br />SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />Afi11it.4 r "T -,J9 te-P 07-1 INIE g vi-- tieq-i c t- i\1 e' t" oN <br />lie/iW ilki i e-t, w t t ei 5 i Ni."--46 et fir -ir it, 57 7 yr try- <br />fi.., -rid .r.- Ateit, L....÷14_. ae-er A t- /4ge<0 Ii AZ E"--z: 7 - 0 0 \ / li 14. <br />6A1 N PA-1---- e L I . s 7 iv --•5 b #p y6 <br />Item/Location Temperature Item / Location Temperature <br />I <br />1 <br />Food Safety Certificat n Facility Hot Water Temperature Warewashing <br />Nam Hand Sink: o F Chlori <br />Am <br />ne: ppm Heat: °F <br />E : Warewashing Sink: o F Quat. m.: ppm Other: °F <br />Received By / Title: <br />EH Specialist: Phone: 2,09 ,56- /.-- opfz 3 <br />Time in: Time Out: Page/ of / <br />EHD 16-24 (2'd pg) 4/3/13 <br /> FOOD PROGRAM OIR CONTINUATION