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SAN JOAQUIN COUP <br /> �Y �+ ENVIRONMENTAL HEALTH DEPARTMENT <br /> _ __ 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Cq.. ;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: Lr ���L �-A 1 o5 Date: _9 <br /> ddress: -�--I I �J \ �` City: S � �C Zip Code: S Z <br /> Owner/Operator: ` _ -_-L�C Telephone: ...,y _ O2- <br /> Program Element: —� Pro ram Record: \b0 Inspection Type: <br /> VB180 Posted ❑Yes Rermit Posted es - I Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> AV-1 I <br /> (e <br /> 3 L - o.,-Q- 1 <br /> S <br /> 2,ae"A • \ \01 1o, -�1 1 2 <br /> O v _T o. <br /> \LL . <br /> �<. <br /> Item/Lrz stt_ =' Tet nature ItemILOCdUp!# Temperature <br /> 17- <br /> Vol F C C) PCL CC/0 I <br /> Facility Hot Water Temperature Warewashing <br /> el\\ �\ _� of PPm _._.. F.,, <br /> Name: �1 LHd Sink: Chlorine: Heat: <br /> Exp.Date: �_ Z _ washing Sink: `,� F IQuat. Amm.: PPM IlOther. of <br /> Received By/Title: <br /> EH Specialist: V <br /> Phone: iN b_ <br /> Time in: ;1 �\ C Y\ Time Out: 1`� 1 J Page�f 2— <br /> EHD 16-24 (21°pg) 413113 ) ` FOOD PROGRAM OIR CONTINUATION <br />