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SAN JOAQUIN COUS <br /> r' Z ENVIRONMENTAL HEALTH DEPARTMENT <br /> 0: X <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • �q .. :a;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: ` CA 1 -Lg20 rt.4_ Date: 5_71 7 S <br /> Address: 2,•L33 /511 rAvi KLeLk City. Zip Code: a5 2.0 <br /> Owner/Operator: 1 1.� b��j,-t and —FY m4 rq Le_.� Telephone: 'I _ l $3 <br /> Program Element: 2 Program Record: P R 2 4406 0 Inspection Type: <br /> 6180 Posted ❑Yes ❑ Rermit Posted ❑Yes ❑ 1 Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> U d-"7 UJ --1 _29—/ <br /> Y <br /> -�1 ton le-s CW - tU a 1 - -r► _��_cam -i �->� <br /> ItemtLocation Temperature ( Item I Location Temperature <br /> n _ <br /> 1 Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: of Chlorine: ppm Heat: 'F <br /> Exp.Date: Warewashing Sink: 'F Quat.Amm.: ppmOther: of <br /> Received By/Title: <br /> EH Specialist: /; �L L Phone: 4 /� <br /> ime in: 7 Time Out: O Pagel of <br /> EHD 16-24(2n'pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />