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SAN JOAQUIN COU <br /> N`. ENVIRONMENTAL HEALTH DEPARTMENT <br /> _ = 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> a;P Telephone: (209) 468-3420 Fax: (209)464-0138 Web:vvww.slgov.org/ehd <br /> /FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: LAIULhA U4-e n Oct Date: <br /> Address: 1&*3-;2. l F <br /> PO G .� �e City: Zip Code: <br /> P0 <br /> ' oto e.�+o r1 9 520 <br /> Owner/Operator: 'Do <br /> LP4 (A 1+o <br /> a n LAALk- Telephone: 44a 1-6417 <br /> _6417 <br /> Program Element: I Zy Program Recor Inspection Type: � nS <br /> B180 Posted Yes ❑ Permit Posted jt Yes ❑ I Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> LJ A., 44f n 3- LL -15 ,- <br /> r� - <br /> Item/Location Temperature Item E Location " <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Na <br /> _ _ _ �-_ — _ <br /> ame: and Sink: LhIo Heat: <br /> °F '{� I.17 fl ppm °F <br /> Exp.Date: arewashing Sink: of m.: ppm Other: of <br /> Received By/Title: <br /> EH Specialist: Phone: — I <br /> Time in: Time Out: Page of <br /> EHD 16-24 (2^d pg) 413113 FOOD PROGRAM OIR CONTINUATION <br />