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ApoPa�coo SAN JOAQUIN COUI <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> c4��FOR��p Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.segov.org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: L IA Qh6 WWAVj Date: <br /> Address: �Z . 'L 1 b c f a6b � City: -� Zip Code: 2_0 <br /> Owner/Operator: + un 6 �G't1-O�1 6 Telephone: _ <br /> Program Element: .1610 Program Record: 1 6 i�U r, Inspection Type: n1 <br /> SB180 Posted Yes No Permit Posted Yes t No K/ Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> to ImId 1 S.- li 'N S <br /> d 1 S A, V� <br /> Led PrWT,_ &;-t- C) TI CQ„ Cl root <br /> Item/Location Temperature __Item/Location— Temperature <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> . .... _ . <br /> _..... ....... . ........_....:__.... -- - --------- -- - - -..........---.............__...._._..........._..__.._....--- <br /> Name: Hand Sink: of Chlorine: ppm Heat: of <br /> Exp.Date: Warewashing Sink: of Ouat.Amm.: ppm Other: of <br /> Received By/Title: <br /> EH Specialist: Phone: ('? <br /> Time in: 0 <br /> Time Out: Page I-3 <br /> EHD 16-24(2n°pg)4/3/13 FOOD PROGRAM OIR CONTINUATION <br />