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of`.gkwIV' C, SAN JOAQUIN COUI�( <br /> 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.sagov.org/ehd <br /> ��FOR�1 <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: L_ 6 C1,6/i` �'�� Date: 3 c 3 <br /> Address: A adlP City: Zip Code: <br /> Owner/Operator. /f f/ uc l� Telephone: <br /> Program Element: Z Program cord: D Inspection Type: <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> t1rhK <br /> ehA Id 7n <br /> Food Safety Certification Fac4hy Hot Water Temperatur'e­s Warewashing <br /> Name: j �, ;f ;/,, ' r Hand Sink: -F Chlorine: ppm Heat: -F <br /> Exp.Date: 12-- <br /> � i i Warewashing Sink: C aF Quat.Amm.: ppm Other: of <br /> Received By/Title. <br /> EH Specialist: l' Phone: C <br /> J <br /> Time in: (�n Time Out: Pagezof Z_ <br /> EHD 16-24 (2nd pg) 4/3113 FOOD PROGRAM OIR CONTINUATION <br />