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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.sioov.orD/ehd <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />Name of Facility: LA j 6/J 4 <br />R E A V <br />5 tPO S <br />Date: C l_ L G` <br />Address: 5 <br />City: <br />5 -roc Twj <br />Zip Code: <br />1� 2.JD <br />Owner/Operator: <br />Telephone: <br />Program Element: Program Record: MOW) <br />833 <br />Inspection Type: <br />N <br />B180 Posted Yes No Permit Posted <br />Yes No <br />Re -Inspection on or After: <br />S <br />AND CORRECTIVE ACTIONS <br />Item/Location. <br />gEy A 19, 3- bR r'n*' col <br />—VK coopf?- <br />-tywe 3--Diz coo <br />od Safety CertHlca:_ <br />Name- tj DG I 1E- MO�Ii� <br />1_O <br />mperature <br />4z>w <br />cility Hot Water Temperature <br />and Sink: eOO <br />Item J Location <br />.F Chlorine: <br />Warewashing. <br />Heat: <br />PPM 11 <br />Temperature <br />! - <br />of <br />Exp. Date: �_ i 15 O� <br />1 <br />arewashing Sink: <br />22, <br />=F <br />Ouat. Amm.: <br />PPM Other: <br />.F <br />Received By/ Title: <br />EH Specialist: `` A IWU <br />Phone: 2 0 <br />✓D <br />Time in: <br />Time Out: <br />Peg of <br />EHO 16-24 (2m Pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />