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SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East HazeIton Avenue, Stockton, CA 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sigov.orq/ehd <br /> <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />Name of Facility: La tA 0-1 i \---6 Date: <br />Address: \--O ‘ C - SammEinto City: <br />-°c - <br />I Zip Code: q,-4o <br />Owner/Operator: loSse- 0 chc cA Telephone: 0 42 _9 1 <br />Program Element: kfcC3 Program Record: siz. c el- 510 (c, Inspection Type: ciinc\A ItrAtiog <br />SB180 Posted 0 Yes 0 Rermit Posted 0 Yes 0 I Re-Inspection on or After: .,__— <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />v i),I 6 GI DJ ?•32-95s5 90 3I-t- <br />(I) FizuvIcle utio-F-IN 4est- stx- v.r› <br />@ V12.0.1-ide, 0 tpc.rl 1-konaws Cor-i-icake, m Go 6c S i....400 <br />CV o 1 - C n O -c-ood Vtinc12A ud fvf. ril 01417112A i cec IGIA4 C <br />(_, \A. e, G ---ooci cyFode syo-i-iftlQ .c--cir -pi-tz (Al2:tdc11/2-, <br />?clavicle 0 &plash quo 1-6) \,0.-1-tveor) -1-i-Le- ‘Ioncl so v-- arc) , ,, c um? (gm y Trot is At- \o;- (c), \Iv, <br />X- cx -tois,_c\ke reilz-rki t a f-ieg vi-Le, <br />Ke, ok- qt)._c) a I-S FA 0 . F-- = t li97J5 <br />- q I 011 \4ok4-e/c 4c-A4-e-c . <br />- zi-c-- cic01c7N <br />Item/Location — Temperature , <br />1- 1 v <br />Item / Location Temperature <br />)--40ki 114112-- FV-ei? (06 .12f. <br />t)- fir NoV-1) coota- <br />S)-1-ao.ii 11* i (c() <br />Certification Food Safety Facility Hot Water Temperature _ , . <br />Hand Sink: k 00 .F <br />Warewashing <br />Name: Chlorine: ppm Heat: °F <br />Exp. Date: Warewashing Sink: 1.2.0 .F uat. Amm.: ppm Other: °F <br />Received By / Title: <br />EH Specialist: .... I.,...... •Phone: 9..001 _ dip - t <br />Time in: 1_ 2 400 I Time Out: : 2.c--- Page I of( <br />END 16-24 (2nd pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION