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01'aSAN JOAQUIN COUNTY <br /> H: X <br /> ENVIRONMENTAL HEALTH DEPAR WENT <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: �an(' L q_l 1 ", i V�?_ Date: 1 G <br /> Address: 14.2 <br /> 2.1- i'1:,KJ-- � g <br /> Y City: 5-4— � Zip Code: 52_0� <br /> \ 7�� <br /> Owner/Operator: ' R N Telephone: `"t _ /r <br /> Program Element: C U C)o Program Record: CO UU 2 �-a/a Inspection Type: <br /> S8180 Posted Yes No Permit Posted Yes No l Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> —'V1 0 0 S.�W ON INEUY ODW CQC*-%-0 1 iGA <br /> Item/Location Temperature Item/Location - Temperature <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: of Chlorine: PPM Heat: of <br /> Exp.Date: Warewashing Sink: of Ouat.Amm.: ppm Other: of <br /> Received By/Title: L U(� L) I <br /> EH Specialist: Phone: <br /> Time in: q,0 Time Out: : Page lof <br /> EHD 16-24 (2^a pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />