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SAN JOAQUIN COU" <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> _ J. 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax: (209) 464-0138 Web:www.si4ov.org/ehd <br /> �/FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Lur (1a Y Date: _ ;z 12 <br /> ddress: ( . 0 ( Na City: Fp �- Zip Code: L <br /> Owner/Operator: a e. 11' ) 1Telephone: cJ yo J�,l <br /> Program Element: 111 Program Record: 05 X&LI_72 Inspection Type: -120 <br /> SB180 Posted Yes F Permit Posted ff [ Yes ❑1 Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS f <br /> FPO r C.e_r cA4.P_ -70 m <br /> h hL4 Com' eheA <br /> c 4iate . r r -1- LA <br /> r we-I rs in re rn oL-4 h f a,n <br /> OD <br /> a <br /> ow <br /> c. j'1 0 "n r)'1.�, rf> PriovicbL <br /> i +z%_i <br /> (.,c a , --V' r01,.4'h _'S' L,0 n b -1 <br /> cooCee-_-, Pro b <br /> 47 ro fir' <br /> f' ItemlLocation Temperature Item 1 Location Temperature <br /> -2- dooms <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: u� of Chlorine: ppm 'Heat: F <br /> Exp.Date: arewashing Sink: 0 2 of Quat.Amm.: ppm Other: of <br /> Received By/Title: p <br /> EH Specialist: ITPhone: h(T� <br /> Time in: 5o Time Out: ` + / a Pan of <br /> EHD 16-24 (2otl pg) 413113 FOOD PROGRAM OIR CONTINUATION <br />