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SAN JOAQUIN COUP <br /> Z-+ ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> 4•./F :P Telephone: (209) 468-3420 Fax: (209)464-0138 Web:www.sigov.org/ehd <br /> ORA <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: I U I LR, L Fe(AM Date: <br /> Address: 1 L City: S �,_J-Cyn Zip Code: C42' <br /> Owner/Operator: LJ L U� i n pr�Wi <br /> n U Telephone: lb-,751�,— <br /> Program Element: I W3 Program Record,.' S Uri} 2_-2 W,Z Inspection Type: (OPW It t1 L <br /> 1 <br /> IS 6180 Posted ❑Yes ❑ Permit Posted ❑Yes ❑t Re-Inspection on or After: � <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> - <br /> NU CcJ'iT cI�S <br /> Gk t SSI `� ,�r'n�-� �-f Ae e- <br /> t s i - = (03 <br /> ItemiLocation <br /> `' Facility Hot itYater Temperature ilY rewashing -- <br /> Name: Hand Sink: ofChlorine: ppm Heat: oF� <br /> Exp.Date: Warewashing Sink: of uat.Amm.: ppm Other: of <br /> Received By/Title: <br /> EH Specialist: Phone: <br /> Time in: e � + 0 (IF Time Out: (2) C.) V Page of <br /> EHD 16-24 (2n,pg) 4,'3/13 FOOD PROGRAM OIR CONTINUATION <br />