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SAN JOAQUIN COUP <br /> 4 X ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax: (209) 464-0138 Web:www.s4gov.org/ehd <br /> LIFOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: ft L�.ti G Date: <br /> Address: y� 3 s � a O City: St,sn Zip Code: <br /> Owner/Operator: ca(I vS �r 1'1Q Telephone:/Y AI` 2� <br /> Program Element: l b rogram Record: � U` �k U [ Inspection Type:"1 7 <br /> SB180 Posted Yes Permit Posted es No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> --- .........Cv ....ll _ Sifl``- <br /> Nl"h-),,Of U"- PTzw& lou <br /> 0 ,C) <br /> �raNIA_\4VS VSi n WPP �-r '�DCO 6.120 "-4e< <br /> SSM <br /> "orwin ot ls Dcne r0 i40y"Initi wo, <br /> - C 1 SWy L- 'S u rr S`n CrC�11t e acApi;S Vilrhm, <br /> oo tw r QF4 c a "iR 4DIlw <br /> �� o�nd <br /> _ _ ..... --- - -- <br /> Item/Location 1 Temerat <br /> pure item/Location Temperature <br /> 26F- 'BON ofl2_ <br /> Food Safety CertificationFacility Not Water Temperature Warewashing <br /> Name: rl y { Hand Sink: �F Chlorine: 1 I ppm !Heat: �F <br /> Exp.Date: I arewashing Sink: i ZU of Oat.Am .: S� ppm Other: of <br /> ter, <br /> Received By/Title: <br /> EH Specialist: Phone: /1 <br /> Time in: !�I S Time Out: o , Pagf7f 2- <br /> EHD 16-24 (2nd pg) 4/3!13 ' FOOD PROGRAM OR CONTINUATION <br />