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ap'"• SAN JOAQUIN COUN1 <br /> A ENVIRONMENTAL HEALTH DEPARTMENT <br /> q: < <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> �4clFedap.. Telephone: (209) 468-3420 Fax: (209) 464-0138 Web:www.sigov.org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: L65 7, 4 a ec,5 Date: 3 <br /> Address: 17 City: S 4 ,J Zip Code: <br /> wnerlOperator: > K Telephone: <br /> L e c; N 6r Ire <br /> Program Element: 13 Program Record: Inspection Type: 904! i^n <br /> 8180 Posted F' D Yes D Permit Posted D Yes 01 Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> ( S !st <br /> V; A > > <br /> G. SC In s 0 r n i //y a a: r i o 2 Wt. Y5 <br /> p, ov; C k oadf 114aLnanrr (erl 'freaIC I ✓YIO/f4h <br /> 3 aCh •i r (AAfn r 4, Gil- �/3 •r. u; a 17011 .V ge, a4cr <br /> al o r brla„) #I.r" Carr .f l s� <br /> G OrQ0V ; 6tQ C�r; Ae es-IS41 1 eel <br /> 6 <br />)1 Callo/% IJ : A40,J scrarnS' let re 2._WenkC. <br /> Ptoy z do hol u/4lcr aF <br /> Q. U o U15 rCC rrs have 1, rr Ap;A <br /> Sgn; �ltrr, 9ca m h/cr• <br /> ItemlLocallon Temperature Item I Location Temperature <br /> Reach • ; n UJY= W21-15 Y?4n hl l 3S F <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: an hlorine: ppm Heat: `F <br /> es;I;C4 plGm I me t <br /> Exp.Date: f7( z , / arewashing Sink: ' eF uat Amm.: ppm ther: eF <br /> Received By I Titl . �PY" J <br /> EH Specialist: Phone: II0 y <br /> Time in: `J 1 is +u S Time Out: Y` I: S?) Page of/ <br /> EHD 1624 (2�gg) 413113 FOOD PROGRAM,OR CONTINUATION <br />