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,oPA .soG SAN JOAQUIN COUt <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> _ 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • .. ;p Telephone:(209) 468-3420 Fax:(209)464-0138 Web:www.slgov.org/ehd <br /> 9GjF�Rd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: /Lam.63 V, 1 Date: i ( k & j <br /> Address: 233 S 1,,.\ City: ` Zip Code: q .5 Z>A <br /> Owner/Operator: -7 \ ` 1 Telephone: 2 <br /> Program Element: 'L� Program Record: ` I S Inspection Type: <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> CC-` <br /> dF <br /> ' w � <br /> cN <br /> \ ` R <br /> \ GJ._ <br /> CN-L Sc <br /> item/LocationPmwmw"TwwwTemperature Item J Location"° Temperature <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: OF Chlorine: ppm [Other: <br /> eat: °F <br /> Exp.Date: arewashing Sink: of Ouat.Amm.: ppm of <br /> Received By/Title: <br /> EH Specialist: Phone: <br /> Time in: 1' Time Out: 2_' 1 Page of <br /> EHD 16-24 (2n°pg) 413113 FOOD PROGRAM OIR CONTINUATION <br />