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;oP .�oG SAN JOAQUIN CO, ' <br /> y ENVIRONMENTAL HEALTH DEPARTMENT <br /> N: X <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • �4.. ;p• Telephone: (209) 468-3420 Fax:(209) 464-0138 Web:www.s'gov.org/ehd <br /> ��FORa <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: lk ca v, LIcj I <br /> Date: <br /> Address: City: ,y� Zip Code: <br /> Owner/Operator: ` v Telephone: <br /> Program Element: Program Record: Inspection Type: <br /> SB180 Posted `Yes ❑ No Permit Posted [-]Yes No Re-Inspection on or After: 3 /A <br /> J ��CC <br /> BSE£V ©NS ND CC?RRE UE1L'TC3NS <br /> v <br /> 1 It- <br /> tJ Wa VIPt OLVI✓ k i <br /> K a vk kW-a4I� s (A C.e <br /> 3 r'I�v rte e�vv�- !�d �, ✓� end �-r�,� `ce <br /> M' <br /> .�� - D� d� W 1 ✓moi�i �- �u �' . <br /> v1-L✓t u - <br /> ` u hr kn,'� <br /> >r I� <br /> C 1N aA V. <br /> V . <br /> a u — n <br /> 1! 7.­ <br /> Item/Location ", Temperature Item/Location Temperature <br /> It <br /> sao f 1 <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: of Chlorine: ppm Heat: of <br /> Exp.Date: Warewashing Sink: Z of Quat.Amm.: ppm Other: of <br /> Received By/Titl <br /> EH Specialist: 'n�, �v� Phone: [ <br /> Time in: Time Out: t Z3 J Page2of Z <br /> EHD 16-24 (2n"pg) 4/3/13 , FOOD PROGRAM OF CONTINUATION <br />