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6Ftw!Y o SAN JOAQUIN COUI_ <br /> y� ENVIRONMENTAL HEALTH DEPARTMENT <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 /> LIFOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: 077 V717-77 777 1' 11 Date: <br /> Address: Leo <br /> City: Zip Code: <br /> Owner/Operator: Va 4-7'On Telephone: (134- <br /> Program <br /> y/ <br /> Program Element: I,?) Program Record: d� ��5 2(40 Li-Z Inspection Type:fi <br /> 6180 Posted jkYes ❑ Permit Posted F 5(Yes ❑f Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> Y ,-O,- VICA n as, .AL�3 t-V w.e t cLf_ a.+�-zaes r I c�c.i� s n •-1-�'a,2 <br /> Di i I.c_ 4 <br /> �- vtot � 6z"-.�I� Loi-c�K-s c.v r_ d �,c�o�.�-e r ro -}D da <br /> 6-qr 1 -F-loors a,Ws Ye_ no ckq+ 7-? <br /> 0-GAv_-: l c.,LA.ol n lon I vi e�c_ 'q Y1.0( rn.P-e_cl.cc1 <br /> FIUD'✓ S1rtS �IA 5i c 2 - rl VJ-+ l <br /> boa.+s W a L4 La_e-e b `{ t 9 <br /> *c C.t4 _4+t- — Ca- L.,e 6. <br /> W�-1-h Lc..tA W ot,l e <br /> C0.4-li lLej2ka c-A- loc, W <br /> Item/Location ; Temperature I Item 1 Location Temperature <br /> 136 yI `7�1- , <br /> f • LAI 1 LID° N h.o C.h e se 1,107- 1 <br /> t36F apa L)K4e, f5o <br /> orVF_ <br /> Food fety Certification Facility fiot Water Temperature <br /> ame: Hand Sink: of hiorine: ppm eat: 7oFExp.Date: a aching Sink: 2� o f uat.Amm.: ppm ther: <br /> op Received By/Title: <br /> EH Specialist: _ _ /_ Phone: 5 7 1 7 <br /> Time in: 5;2)6• CiYI�L( Time Out: Page, <br /> EHD 16-24(2,dpg) 4/3/13 FOOD PROGRAM 01R CONTINUATION <br />