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PQu�" SAN JOAQUIN COUI• <br /> � •.OG <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.siaov.ora/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: L4 a /A)4Date: _ Z <br /> Address: -7S � - City: Zip Code: <br /> Owner/Operator: v Telephone: <br /> Program Element: r Program Record: I a G O� Inspection Type: <br /> F13180 Posted Yes "o Permit Posted Yes "o Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> rn D►'I eid r fru- , Qdyoct'rt_ <br /> C/N ,� ' aA 4111 <br /> �G , • -0 of�-c i f 710d " 5,5� <br /> O Coi e�fi �3 <br /> � d L- z -r sea-19 ae4,d W 64-t <br /> '4 l lvvl� •c <br /> -il-e w'el AO /_ 1)e's 4oam' <br /> c do t t'�,c7 (-4- 00 &," <br /> G��Y�-- a CX-_6e'1_ <br /> .L,eFS G�GG�c d <br /> 00 o Q n d C� oc �17 4_7G <br /> h o-s - — s A <br /> 1 - Lo-Gly o-f- &m4tj �aP a414.4- S - <br /> i)1 L IF n'e f F&PW S r <br /> Item/Location Temperature Item/Location Temperature Item/Location Temperature <br /> V <br /> rte O` 13 SG <br /> Food Safety Certification Facility-Hot Water Temperature Warewashing <br /> Name: Hand Sink: //0 of Chlorine: ppm Heat: 'F <br /> Exp.Date: ,7- are ing Sink: /,3S_ of Quat.Amm.: ppm Other: °F <br /> Received By/Tit e: <br /> EH Specialist: Phone: <br /> Time in: 30 Time Out: Page of <br /> EHD 16-24 (2"d pg) 4/9/12 FOOD PROGRAM OIR CONTINUATION <br />