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PQu," <br /> SAN JOAQUIN COUN <br /> �o.��.coo <br /> ya ENVIRONMENTAL HEALTH DEPARTMENT <br /> X <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • � .. P• Telephone:(209) 468-3420 Fax:(209)464-0138 Web:www.s4qov.org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: lfl(, t7 n l i� 3�L"2q Date: ) _ <br /> Address: G 1 i h S t City: C Zip Code: <br /> Cr- 953 ;l' c <br /> Owner/Operator: Telephone: <br /> rrn i Sc h,,der 2z1- iT2c <br /> Program Element: 162 5 Program Record: s 3 d �b Inspection Type: <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> C}BSERVATIONS ANQ�ORREGTtVB,ACTIONS <br /> tS V;a dy S G o f r l ej" <br /> _`__._........_ .� _ !.�7 ✓: (��r ; n i/ V 01 r PW C r a t k e u r ort_.._Si._►' <br /> Or <br /> Item/Location Temperature Item I Location Temperature <br /> Food Safety Certification =Facility Hot Wafer Temperature Warewashing <br /> --- — <br /> Name: Hand Sink: 'F Chlorine: ppm Heat: `F <br /> Exp.Date: arewashing Sink: -F Quat.Amm.: ppm Other: -F <br /> Received By/Title: <br /> EH Specialist: - one: -.7 <br /> Time in: yg Time Out: d Pagej of <br /> EHD 1624(21,'pg) 4/3+13 0 FOOD PROGRAM OR CONTINUATION <br />