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<Tow* <br />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.siqov.org/ehd <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />Name of Facility: Li a i taw 1-j V -4- Ll-VA n23 Date: II H, k! 21-2f.__ <br />Address: 00 L 0 cti)06 _,,N-Q, *Ci <br />City: (j0c/tk Zip Code: of 0 <br />Owner/Operator: Lt rAi01\Q i 1 (1.- <br />Telephone: <br />rogram Rec d:/12 ? '‘_\ C Inspection Type: P ilf)- O P„),• ---).k. Program Element: lo <br />SB180 Posted Yes Permit Posted No Re-Inspection on or After: <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />l.. <br />0 IIPOWCP 0 rillfiliWi ----1(2 na—c-Of4-= / i <br />I <br />(0-1Aill-t, Iv inc‘Rcyf-tuYI, nO utipy vG-11-1,N <br />n 0 vs,_,A rc,pe 0-1,4y-i , <br />V......_ Iv wke 2_04-s xLn4/01- tY)Le> <br />prtkk .-R,e i-- caAA- <br />Item/Location mi. Ait Temperature 710Nr ' Item' / to'cation rature <br />Food Safety Certifi Facility Hot Water Temperature Warewashing <br />Name: Hand Sink: o F Chlorine: p pm Heat: . <br />Exp. Date: Warewashing Sink: o F ()oat. Amm.: ppm Other: . <br />Received By / Title: <br />--7 EH Specialist: a. <br />Phone: al)Ct (.0 i to 3 ( <br />Time in: Time Out: Page lofi <br />EHD 16-24 (2^d pg) 4/3/13 <br /> FOOD PR LI <br />PK 2L1 W-2:2