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°"r" SAN JOAQUIN COU'. t <br /> Z� ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> .. ;P Telephone: (209) 468-3420 Fax: (209)464-0138 Web:www.sogov.org/ehd <br /> LiFORa <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: _l <br /> Address: "l -L Y 1 o r- City: c��� Zip Code: <br /> Owner/Operator: Lk �* —'T q 1'l_Q. Telephone: L <br /> Program Element: 1 , fZ _ Program Record: �1 , �^7�v Inspection Type: 12 L <br /> S6180 Posted 1 VJ Yes CI Rermit Posted ❑Yes ❑ I G O Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> `? <br /> f-a4_t C:_Q_ g_ ot Y c� CLQ-Ct n d rug <br /> lb I re r)ck r n-p-Q4-h cn o <br /> (._6\ O`12✓1 f-e1.Z 5 C� n D <br /> W Cin 10 r%n-0- -k,5+ 5-A-6 S Yt si- a u o-- (a _-;,U <br /> a Le AID <br /> r e CL oviaw Afy-b m o <br /> w L LPeA-e r I U 8 V--ercL -•e_ <br /> YtOC ae V4P_ 1'1 'h <br /> . � <br /> .............. <br /> Food Safety Certifications ; a P :: • , ,< , <br /> A <br /> � r. <br /> Name: Hand Sink: of Chlorine: ppm Heat: of <br /> Exp.Date: Warewashing Sink: of Quat.Amm.: ppm Other: of <br /> Received By/Title: <br /> EH Specialist: Phone: Q <br /> Time in: n Time Out: _6 I c) Page of <br /> EHD 16-24 (2nd pg) 4//3/13 l FOOD PROGRAM OR CONTINUATION <br />