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,aa .�oG SAN JOAQUIN COUI <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • ��..• :.•;P• Telephone:(209) 468-3420 Fax:(209)464-0138 Web:www.sigov.or- /q ehd <br /> �i�oad <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: L�wJ> Date: V/3/7 <br /> Address: City: Zip Code: <br /> Owner/Operator: 0 — rUl/WV Telephone: <br /> Program Element: ' !- ' Program Record: 0 U/, ( — Inspection Type: /I <br /> SB180 PostedXYes U No Permit Posted Yes No Re-Inspection on or After:�W <br /> OBSERVATIONS AND CORRECTIVE ACTIAix J14 6w 4P - <br /> ONS <br /> J4 L/V1 <br /> Item/Location i Temperature Item/Location Temperature <br /> Food Safety Certtf�caton Facility HotWafe�,Tgmperature — -- Warewashing <br /> Name: k <br /> d Sink: <br /> � Q � aF Chlorine: PPM Beat: �F <br /> Exp.Date: �0 arewashing Sink: 15 of Quat.Amm.: ppm Other: of <br /> Received By/Title: <br /> EH Specialist: Phone: <br /> Time in: •.-, Time Out: Page�of <br /> EHD 1fr24 (2n0 pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />