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SAN JOAQUIN COUN' <br /> •.OG <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> c4�/i=oRa�P Telephone: (209)468-3420 Fax: (209)464-0138 Web:www.sigov.org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: L1 0 r- Date: 3_2 4 <br /> Address: ,$6i6 L—Ower SacrQ, �� /�1. City. S ��fU Zip Code: ��Z1 <br /> Owner/Operator: 1 Telephone: <br /> Program Element: ( bo Program Record: 5 e17 3 Inspection Type: C�l�tS� 1 f V <br /> B180 Posted ❑Yes ❑ Rermit Posted ❑Yes ❑I Re-Inspection on or After: <br /> OBSERVATIONS AND CORREGT_IVE ACTIONS <br /> (4- <br /> t ' a tip m-,% s r h(. . <br /> PP( C LI, <br /> ,r fz-QP1 q,""z 2k1 mc5sty� «i, Ire S <br /> t n S r-•T-� ` re4 k 1Y'@A o IV"- <br /> ---- --- ----- --- - <br /> Item/Location Temperature Item 1 Location Temperature <br /> I <br /> Food Safety Certification Facility Hot Water Temperature Ware>+�ra��in� <br /> a . <br /> Name: !Hand Sink: of Chlorine: ppm Heat: of <br /> Exp.Date: �arewashing Sink: of Quat.Amm.: ppm Other: of <br /> Received By/Title: <br /> EH Specialist: AJ L!/�/G Phone: <br /> m✓h <br /> Time in: I cJ 2 v Time Out: ;od Page lof <br /> EHD 16-24(2^d pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />