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SAN JOAQUIN COUNTY <br /> ?a ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> �q•.. ;p Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.sjgov.org/ehd <br /> ��FORa <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: L t h - \\w()J ct Date: l)/zc;/ 1-4 <br /> Address: 3 010) u tzr City: s �� Zip Code: <br /> Owner/Operator: 4 V00CA <br /> Telephone: \4�— <br /> Program Element -� Program Record: (�50G?D':2_1 Inspection Type: <br /> SB180 Poste Yes No Permit Posted No Re-Inspection on or After: <br /> OBSERI(ATlONS AN©CORRECTIVE ACTIONS 0 <br /> - _w1 -� — G &eHR C JCQ ISG V eS N� CICS �6 -- - _-- <br /> pep <br /> �-� <br /> 9—Iromilp S19o+ w i S U 612"x- uS� to UF <br /> 3 s S G cm'kcn •t <br /> W e1e in ix3a r1-_>C � -ce5 <br /> 4 — S urt hc�-� a�c�+ll� n n = <br /> Item/Location Temperature item/Location Temperature <br /> NOOcI e urcw <br /> - - 1 1� --- - - <br /> Food Safety Certification Facility Hat Water Temperature Warewashing <br /> Name: Hand Sink: 1('l, °F Chlorine: ppm (Heat: `F <br /> Exp.Date: are ashing Sink: i 12 of Quat.Amm.: ppm Other. o f <br /> -C� <br /> Received By/Title: <br /> EH Specialist: Phone: <br /> Time in: 10; Time Out: I Page2of <br /> EHD 16-24 (211 pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />