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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web:www.s*gov.org/ehd <br /> ��FORN <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: &L'e- r- Date: <br /> Address: 16)-3Q, '00j / � City: C t/-IV Zip Code: <br /> Owner/Operator: L Telephone: /—53 <br /> / <br /> Program Element: l �p Program Record: 12-0 Inspection Type: jLL 40(, <br /> SB180 Posted Yes uN•oO0 Permit Posted Yes No Re-Inspection on or After: /a <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> 7z�� -r <br /> - :i_� zd= <br /> L/ <br /> ClSe_ ­kV h /�l g)Le _Se4 r <br /> ae-- —c-o s u eve r <br /> m-O rs A <br /> LUr r K] a-F4f Y n DO­7 40 V-0 r l <br /> l'1 a 4- Q <br /> - r o <br /> L <br /> g53��iSf r —1754 c) r <br /> A Y-P_ c <br /> PuZo;*7 <br /> CTS - � �or�,�o m G.r <br /> w7" item/ catiq; �` Tem a Ito, ,•i -Temperature <br /> Food Safety Certification Lae <br /> ty Hot Water Temperature Warewashing <br /> Name: k: �j of Chlorine: ppm Heat: of <br /> Exp. Date: hing Sink: of Quat.Amm.: ppm Other: of <br /> Received By I Title: <br /> EH Specialist: LI�Gi �� Phone: 4?63 _—7 /-7 <br /> ime in: .� Time Out: / / / Page�of� <br /> EHD 16-24 (2°1'pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />