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PQ�I" SAN JOAQUIN COU l <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> . r•., �p• Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.slgov.org/ehd <br /> 9C/FO RN <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: L l Date: <br /> Address: : <br /> 'r�S hQ City: �L�n Zip Code: 9 `J Z� b <br /> Owner/Operator: u Telephone: '%7:3 3_ V7 Z�d <br /> Program Element: Program Record: SSSS / Inspection Type:a <br /> SB180 Posted Yes/ ❑ No Permit Postedo�Yes _ No Re-inspection on or After: <br /> { -to ri -b 0 d 640r� <br /> rns L os-k- U-0 v-' &R_j o me <br /> (Y�' <br /> �tLt r e� ✓Yl 1.k..CX-4 <br /> ova 4-3 r <br /> Item/Location Temperature F Item/Location Temperature <br /> coo C¢ Li 1`f- <br /> I:',jv /Of <br /> �Sv1J_e.�� o fio 1 SIP= <br /> ddo T►-A.�ls L 36, n r� 34'A77 <br /> Food Safety Certification Facility_...._ Hot Water Temperature Warewashing <br /> ---- _— _... -- _:..---- --- -- <br /> Name: /` Hand Sink: /43 b aF Chlorine: ppm Heat: of <br /> Exp.Da . _ _I Ware s 2!in 1qo 'F Ouat.Amm.: � ppm Other: 'F <br /> —f.lJ�� <br /> Received By/Title: R <br /> Ul/ 2x <br /> EH Specialist: �l _ /_ L Phone: <br /> Time in: !®•yo Time Out: 1.11 <br /> Pag <br /> EHD 16-24 (2nl pg) 4/3113 FOOD PROGRAM OIR CONTINUATION <br />