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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> < Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.s'gov.org/ehd <br /> q<IFb.RN� <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: L, VAove Date: LZ T- <br /> ddress: . w S City: LvA p Zip Code: 9S'�KCI <br /> Owner/Operator: CAVV%AvN 9 SNN C4 <br /> Telephone: <br /> Program Element: kboo Program Record:sp 00 U'60 <br /> '60 (kZ-S Inspection Type: <br /> 6180 Posted Yes No Permit Posted Yes No V v Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> L�sP <br /> w � <br /> c-' 1 1 <br /> a <br /> 4 <br /> t M <br /> a s 15 &N a <br /> � 1 <br /> _ - Item/Location' - Temperatures Item I.L'ocation _ Temperature <br /> 4 'F — – <br /> 1 -A/- Nvld k b 1 r <br /> -t- KGS <br /> Food.Safety.Certification Facility Hot Water Temperature L Warewashipg. _ <br /> Name: C 'yyt Hand Sink: U•Z of Chlorine: ppmHeat: of <br /> Exp.Date: arewashing Sink: `-I,c of Quat.Amm.: ppm Other: of <br /> Received By I Title: <br /> EH Specialist: Phone: —,,)%- J_ �74V <br /> Time in: Time Out: V 1 Page of/ <br /> EHD16-24 (F^pg) 4/3/13 FOOD PROGRAM OR CONTINUATION <br /> p�-o5tftd�c u� <br />