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0 SAN JOAQUIN COU* <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> _ = 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.si4ov.orq/ehd <br /> �IFORt� <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Lck 4G ., Date: s <br /> Address: 7 4 L - V City: r w t Zip Code: <br /> Owner/Operator: Telephone: <br /> Program Element: Program Record: Inspection Type: Rcm <br /> SB180 Posted VYes No Permit Posted VYes No Re-Inspection on or After: <br /> h a F OBSERVATIONS AND CORRECTIVE ACTIONS <br /> Ira : In (.Ji 1AP'"a WE kcls W _ <br /> 0 O'd O Ar S(cc, of Cie r. n C. bitG crrp C J 4 � <br /> rulOW Ck I ra c a/ 0 r dr; C <br /> v r- 4. 4� p s <br /> �- a C <br /> nj Ctos /: <br /> •S oVC t above forid on,fq <br /> d r z°rn 4c, 4 cle <br /> am <br /> G Ir n q / <br /> .yi I fA + <br /> �r I Or 1P s3. Ccrrecl kc/4 <br /> ttem/Location Temperature Item/Location Temperature <br /> r ---- -- - -- — --- - --------- I —' ------- <br /> u 5r <br /> � tlafty;Certification Facility Hot Water Temperature Warewashing <br /> Name: An 'IO f1i o <br /> cc4 n at Hand SPk: j4,&4- 'F Chlorine: PPM Heat: 'F <br /> Exp.Date: I Wafewashing ink: 131 of Quat.Amm.: PPM Other: of <br /> Received By/Title: <br /> EH Specialist: Phone: <br /> Time in: ` Time Out: I �1 �I� Pagel f <br /> EHD 16-24 (211 pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />