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SAN JOAQUIN COUP <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax: (209) 464-0138 Web:www.sioov.org/ehd <br /> �rFOR� <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: r -.4ev4a JAC <br /> Date: <br /> Address: 2u W Ll G I- VJCity: ��--� �� Zip Code: G5 9o� <br /> ` <br /> Owner/Operator: Le'. ek G Telephone: 1 0 _001/Y <br /> Program Element: I f� Program Reco d: b 2�/"1 _ Inspection Type: IOY/ cftk n <br /> B180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: _..___._.__ <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> CJCYe <br /> Item/Location Temperature Item t Location Temperature. <br /> Food Safety Certification. Facility Hot Water Temperature Warewashing <br /> Name Hand Sink: of E <br /> rine: PP m Heat: of <br /> Exp.Date: arewashing Sink: of Ouat.Amm.: Ppm Other: of <br /> Received By/Title: <br /> EH Specialist: _ Phone: c� �✓1 - K7 <br /> _ 5 1 _! <br /> Time in: y} (f; Time Out: "l"'� /- Page r of I <br /> EHD 1624 (2^ pg) 4013 FOOD PROGRAM OIR CONTINUATION <br />