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opQ�I" SAN JOAQUIN COUNT <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.sigov.org/ehd <br /> L�FORi� <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: L iDel I Date: I -Z_1'�_ <br /> Address: e"I L City: ` Zip Code: 95 Z 44(=7 <br /> Owner/Operator: t1 we5sc-r !ite r` Telephone: G ZS :`�-70 <br /> Program Element: '6 Z Program Record: O 0 ` ' Inspection Type: <br /> SB180 Posted/-'Yes No Permit Posted/des No Re-Inspection on or After: t <br /> OBSERVATIONS AND CORRECTIVE ACTIONS- <br /> - .. _. _ <br /> TkJL-= PLP=p!-Z( (Se-rr,-�-ot-- rS Ao& Calk -d 4 �' <br /> Px -. <br /> hSl r� t S S Ori—►'+��'c�.2�..� (i�.' l.n � �2 i" C�tx+r 'E'er c��a, <br /> ,.� <br /> I t- t S c ooh OL <br /> L <br /> Item/Location i_Temperature Item I Location Temperature <br /> Pepl tc.;�4z) �= <br /> Food Safety Certification Facility Hat Water Temperature Warewashing <br /> - _ _:._:... -_-------- <br /> - —_ <br /> Name: � b 1 �� PP <br /> Hand Sink: ) �- �F Chlorine: m F <br /> 1 /YI "` � h ,[� � <br /> Exp.Date: arewashing Sink: of Quat.Amm.: ppm Other: aF <br /> d-2 ( 2•_. <br /> Received By/Title: <br /> EH Specialist: � ��_ Phone: `'(�- :2"4 <br /> Time in: „ 0 Time Out: 12 � Pagelof Z <br /> EHD 16-24 (2^^pg) 4/3/13 FOOD PROGRAM OR CONTINUATION <br />