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,oP .�oG SAN JOAQUIN COU t <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • �4. �;�P• Telephone:(209) 468-3420 Fax:(209)464-0138 Web:www.slgov.org/ehd <br /> Cj F <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Von r I,An I L-4 <br /> r Date: 2—q —' <br /> Address: 3 3 S <br /> City: +O < to zip Code: q 5:)-60 <br /> Owner/Operator: �1 ` a�tt'� �-� Telephone: L4(oW_9 -336 <br /> Program Element: Program Record: p p O I ( Inspection Type: T)Lo u-6 riz <br /> SB180 Posted,4,Yes No Permit Posted VYes�l No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> -E« m v ` ► (A rIA'-I- a n of Gli-ar l <br /> Sct k-t-4. 4-)tri w <br /> 2 r LIUh rYL( L i &4,,-� 1'_�+z;L [ nn <br /> r cz-r-Itie s, ems, +i'CK- -S <br /> n 1 L <br /> r wce ) I L".1 ✓ --a'�-0 0 en 4 r a_tt <br /> n-,5 0 Y` ("-4 a& 'P q t,LCL <br /> L <br /> s 5° < ki PW 4- c. .2 -Or <br /> Y-0(/`i <br /> Item/Location Temperature Item/Location Temperature <br /> ' - 1 h <br /> 111.1 <br /> W11 Vl <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> - --------- ---- <br /> Name: yy���� /0y Chlorines H <br /> im. 001 I �_ �F I'NGA�(lt- L.-PPm I,2,Z °F <br /> Exp. Date: arrsbing Si Z 'F Quat.Amm.: ppm Other: °F <br /> Received By/Title: I �� <br /> EH Specialist: Phone: <br /> Time in: SG.� Time Out: I 0110Page of <br /> EHD 16-24 (2nd pg) 4/3113 FOOD PROGRAM OIR CONTINUATION <br />