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SAN JOAQUIN COL 'Y <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> c... ; Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.slgov.org/ehd <br /> 4CjFo'�ia <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: L r �L Date: II.2�-�� <br /> Address: 4 /' ` t City: (57'0 Zip Code: <br /> T7 9 ;7_0`7 <br /> Owner/Operator: /'-3LIC. !'ICi�Z-G Telephone: <br /> Program Element: /& /,;L Program Record: P/Z 05 :?S Inspection Type: - <br /> SB180 Posted Yes No Permit Posted Yes ❑ No Re-Inspection on or After: <br /> L) rh c 1iAu-f a S h <br /> -z-W 4—,L <br /> rrt c 1 r►ds;A-.& <br /> 64L- ro <br /> + pri- <br /> IQ <br /> Us i h YLO YX VLA r,a 5 nc>d <br /> of vi S cpops- <br /> La_"Ca d L-' <br /> Item/Location Temperature Item l Location Temperature <br /> r c,D©CO r <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: qe C414(& Ae, eq r Hand Sink: /3 'F Chlorine: o ppm Heat: 'F <br /> Exp.Date: ' _ W washing Sink: 'F of Ouat.Amm.: ppm Other: of <br /> Received By/Title: <br /> EH Specialist: /_ _ Phone: `-2 <br /> Time in: r�vV Time Out: Pageo <br /> EHD 16-24 (2otl pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />