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SAN .10AC,lUIN COL Y <br /> oma, ...... c <br /> �.••��••.oma <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.sigov.or /q ehd <br /> L(FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: <br /> Address: —1 r _I � 1 Q City: !_1 _ �L•.fO n Zip Code: 2-0 <br /> Owner/Operator: L _ � awl� k, / c�Tv Telephone: G _ Y3 I <br /> Program Element: l I S PWgram Recor . T RD$ $S Inspection Type: <br /> SB180 Posted Yes No Permit Poste Yes No Re-Inspection on or After: <br /> r <br /> OBSERVATIONS AND CC3RRECTlVEAC?IOtS � <br /> -- — — ....... ._._._.—. <br /> ©Ut-c-i- <br /> j Y ct� H t,n �,cJ f► loo r.S <br /> Item/Locatioh _ .Temperature `= lterri/Location I Temperature <br /> �UGYJY `rYU-e._ <br /> Food Safety Certification Facility Hot WaterTemperature Warewashing <br /> �_ . <br /> Name: Hand Sink: �. F Chlorine: ppm Heat: `F <br /> Exp.Date: War wa n Sink: , -F Duat.Amm.: ppm Other: -F <br /> Received By/Title: n -gyp <br /> EH Specialist: �7t L Phone: <br /> Time in: i Time Out: ,L Pagoe L <br /> 1 <br /> EHD 16.24 (2n°pg) 413113 FOOD PROGRAM OIR CONTINUATION <br />