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oP41'" SAN JOAQUIN COU t <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • C4.. — ��P• Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.sl4ov.orq. /ehd <br /> <<POR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: IM VK L LL Date: <br /> Address: 7S^� ; ,t City: Zip Code: '' <br /> Owner/Operator: Al ,'v W Telephone: <br /> 7 e AX, <br /> Program Element: If" Program Record: /�O Inspection Type: 94 <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: .11 <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> oS <br /> 0 <br /> Item/Location Temperature Item!Location Temperature <br /> 14 <br /> Food Safety Certification FHd—S <br /> ility Hot Water Temperature Warewashing <br /> Name: — ink: Z%7 of Chlorine: ppm Heat: F <br /> Exp.Date: ©G'r / �Z Warewashing Sink: of Ouat. mm. ppm Other: of <br /> Received By/Title: <br /> EH Specialist: <br /> Phone: <br /> ime in: Time Out: Page of <br /> EHD 1624 (2"d pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />