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SAN JOAQUIN COL 'Y <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.sugov.org/ehd <br /> ��Fp4tti <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: !' (t-__ / Date: <br /> Address: y a q 1 �—r-(m O�-fl� City: c O n Zip Code: <br /> V Q64141-1910 <br /> Owner/Operator: L•O n S V Telephone: <br /> 'Tl to 4l —! /o <br /> Program Element: Program Record: !� Inspection Type: <br /> SB180 Posted es No Permit Posted Yes No 7 Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> Cjoe- of C&it LA' P 0)Y7 k- S i'v-LA S5 . +� �v n -(- <br /> - <br /> 0'9� --rC:2, 6LOOAQ CaLA' & 'IDn S LA-1 ZIA CA c+c e >n oLAGQ-r- . <br /> c <br /> U n cue r 3—Cs S R4PMr b ,W•e.e�l <br /> COOrS <br /> 6 1 —2-w-o_e.K,s <br /> AA <br /> Item/Location Temperature Item/Location < Temperature <br /> I m 'P ( 5 t� cii 1-10cp <br /> t7° r-s voh o al` 140r <br /> tI ° ��0 GGI.Ct S-c� / . <br /> - 1---- -- <br /> Food SafetCertification Facility Hot Water TemperatureWarewashing <br /> Name: Hand Sink: !- oIC <br /> hlorine: PPM Heat: of <br /> Exp.Date: are as�gS in : /•3.� ouat.Amm.: ��� ppm Other: of <br /> Received By/Title: <br /> EH Specialist: �^ Phone: __22 1 <br /> Time in: Time Out: r C O Page of z <br /> r J <br /> EHD 1624 (20 pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />