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SAN JOAOUIN COI TY <br /> 4 X ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> •.. ;P Telephone:(209) 468-3420 Fax:(209)464-0138 Web:www.sigov.org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: L/VJ _ �• Date: / <br /> Address: )--3 City: Zip Code: <br /> Owner/Operator: C�(.Z /j Telephone: <br /> Program Element: 1e/e Program Record:_f a+ �Dt1� Inspection Type: <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> --- _ _ - _ ---- <br /> Item/Location i Temperature Item/Location Temperature <br /> — <br /> iVvi_-_-llliy�ww✓� _ 11 l l � �, 1,�-e Lt,�ZY <br /> - Food Safety Certification I Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: 'F Chlorine: PPM Heat: �F <br /> Exp.Date: Warewashing Sink: of Quat.Amm.: ppm Other: of <br /> Received By/Title: M G1 <br /> EH Specialist: Phone: <br /> - ---v-Time in:in: Time Out: Pagerf Z <br /> EHD 16.24 (2^'pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />