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oaQ��k SAN JOAQUIN COU Y <br /> ..•• ........c <br /> r. .� ENVIRONMENTAL HEALTH DEPARTMENT <br /> - = 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> �4•..,-,,.a;P Telephone:(209) 468-3420 Fax.(209) 464-0138 Web:www.si.ov.org/ehd <br /> L�FOA <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: VL v ` Date: ` <br /> Address: aIX N City: s Zip Code: <br /> Owner/Operator: "ll/'N Telephone: <br /> Program Element: Program Record: D Inspection Type ( <br /> SB180 Posted Yes No Permit Poste Yes No Re-Inspection on or After: <br /> OBSE k <br /> A lON PIO,CflRRECTIU,E, C ONS <br /> . �... ,- <br /> ---.... _..__..._—_L...._.. S_. <br /> C.e _ COK <br /> / ov-r -Ivy . <br /> ti <br /> 12 <br /> G 144W <br /> 0 — — <br /> Ava <br /> ki <br /> a b V to k-14('i - V yam,, — <br /> s <br /> Itemll_ocatiortt.ocat+orn,�; emperatuce;' <br /> r <br /> L �1VJ <br /> 414 ----. — <br /> Facility Hot Water Temperature 1iYarewashing <br /> Name: Hand Sink: `F Chlorine: ppm Heat: `F <br /> Exp.Date: //t 01 arewashing Sink: F Gluat.Amm.: ppm Other. 'F <br /> Received By/Title: !/ / <br /> EH Specialist: WIT <br /> Q <br /> Time in: _ i Time Out: ]Pag of <br /> EHD 16.24 (2a°pg)4/3113 FOOD PROGRAM OIR CONTINUATION <br />