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SAN JOAQUIN COU <br /> �o.�a.coc <br /> .ya ENVIRONMENTAL HEALTH DEPARTMENT <br /> --_ 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> �q..., .�;�P Telephone:(209) 468-3420 Fax:(209)464-0138 Web:www.sigov.org/ehd <br /> <<FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: r Date: <br /> Address: Lt <br /> 63 5 O G -I;-<, 'A�-J,t City: JTC LU C ,t n Zip Code: <br /> Owner/Operator: 510 <br /> 0 Telephone: <br /> Program Element: u1 Program Record: P (2-0'5-2_31_�3 C) Inspection Type: - <br /> SB180 PostedxYes No Permit Posted )4Yes No Re-Inspection on or After: <br /> OBSER1fAT1{?NS AND CORRECTIVE A, NS <br /> .o�_._, . ..•. � <br /> ! <br /> K006.5'11 5_I..A4L 0 OA4, J2 a Y-.e-Gi (%5 ho 4- YL4_l ' <br /> ---� Ica. -------�2i� ___ I �1-�•e JC. _ . .���,e a;+� <br /> IA_r_ _!�eG V ___.. ---hod a - �Y -Y7 - � <br /> .................... � .........--n— --rv�o- d '----- ...... a __ I_s_ ► _ _ w�-e <br /> r --e_ 40 DV vula l hOl V-P C1 f 6A,1-,S 64 n d <br /> w4AAL <br /> ohA r) r- r i "�e d - 1 ry tir la <br /> Item/f.ocation k' Tem nature '� item/.t.ocabon 7erl�perature <br /> 16;''4117 _ 3,� IY <br /> l <br /> door rr Lr P,4 -� <br /> Cleo r ....... <br /> qeeij w°r- <br /> sa <br /> 1�gOt afAh —"Al, <br /> acility io#YVa erg, emperature 11Yareinrashmg . <br /> �. <br /> Name:J 1Q r" S_ Of t WLA 9 Hand Sink: a le4o -F Chlorine: PPM Heat: 'F <br /> Exp.Date: 11,y _ f.. washing Sink: �2/ of at. mm.: PPM Other: 'F <br /> Received By/Title: 5� la <br /> EH Specialist: urPhone:chm 427 <br /> —..._-....__..__._.__✓J O <br /> Time in: Iz•;0 Time Out: 1J Pageef <br /> EHD 16.24 (2n1 pg) 413113 FOOD PROGRAM OR CONTINUATION <br />