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a <br /> SAN JOAQUIN COUP <br /> Z ' ENVIRONMENTAL HEALTH DEPARTMENT <br /> N. <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> •.. ;a Telephone:(209) 468-3420 Fax:(209)464-0138 Web:www.sigov.org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: PA7,eO LAV_ Date: / <br /> 6 7 713 <br /> Address: F Th — City: Zip Code: <br /> Owner/Operator: '//JL�e t:h /? .rf711ZI Telephone: <br /> Program Element: Program Record: Z Inspection Type: <br /> B180 Poste O'Yes 0 No Permit Poste 2 <br /> Yes 0 No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> 1 - YU t4 f/vl <br /> Ot - <br /> S <br /> My, WiPI&I <br /> Item/Locati n Temperature Item/Location Temperature Item/Location Temperature <br /> V— ✓ ✓1 WI (� ,- 3� <br /> `GU D <br /> _Food Safety Certification - Facility Hot Water Temperature Warewashing - <br /> Name: Hand Sink: /tL 'F Chlorine: ppm HealF <br /> Exp.Date: Warewashing Sink: 'F Ouat.Amm.: ppm ther: 'F <br /> Received By/Title: 1 ) <br /> EH Specialist: SY 1 / Phone: <br /> Time in: r1 0 Time Out: Pag�of <br /> EHD 1624 (2b pp) 4912 V FOOD PROGRAM OIR CONTINUATION <br />