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SAN JOAQUIN COl • -Y <br /> � '•OG <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> X <br /> - 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.slgov.orp/ehd <br /> <<FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: LC)6-i w CA ��� Date: "__'F <br /> Address: �. ctC r, v/I(���{ Ci City: V"Y1 Zip Code: <br /> Owner/Operator: C 'e _ J�1 Telephone: <br /> L- � <br /> Program Element: 1� .rim Program'Record: 1P(2 � jC t c)(.-- Inspection Type: � r- <br /> SB180 Posted Yes No Permit Posted Yes No L' Re-Inspection on or After: <br /> c- <br /> 00, <br /> r -�s <br /> • m S c(i \jn(w Ke SDmTVS pec a+ all <br /> sr n ocw c r cA G111 fi <br /> NO SGm - 0 v 1 S 1 <br /> banar6 tS <br /> - Wo r_d06ISrd N unCvYCW <br /> CkVfW G S S W 0f]I2 a w.P1� w alb VAJS <br /> 'wfly ; <br /> W,t Ccoaed Cid► S are vncry . <br /> ot C01 t� . <br /> c+Gi 11- 'VV_1I11 .e "t i--me c cn-tza frA- ri U <br /> -F-1JP.r �S blim 11C0(*-� <br /> [bits Temperature Item J Location Temperature <br /> _ <br /> j Certification Factlity Hflt 1Na�r Temserature War washing <br /> Name: Hand Sink: `F (Chlorine: ppm Heat: 'F <br /> Exp.Date: Warewashing Sink: `F IQuat. Amm.: ppm (Other: of <br /> i <br /> Received By/Title: <br /> EH Specialist: Phone: <br /> Time in: �� : Time Out: :5V Page of <br /> EHD 16-24 (211 pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />