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SAN JOAQUIN COI: Y <br /> P <br /> �0. •COG <br /> .Z� ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> �q...• ...�;;P Telephone: (209)468-3420 Fax:(209) 464-0138 Web:www.segov.org/ehd <br /> ��FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: L t, i 1_4 ryi-A ri 1w r Date: 141 q <br /> _ <br /> Address: faot l S b�r L Cit 4 Zi Code: <br /> V y• S ocl�+�✓� p 20 <br /> Owner/Operator: Telephone: <br /> 955- 66 <br /> Program Element: 10 '�- Program Record: P f] o(u O Inspection Type: -120U rte, <br /> SB180 Posted Pes No Permit Posted Kyes No Re-Inspection on or After: <br /> QBSERVAT16NS ANQ C iRRECTIVE ACTIONS <br /> Wab-k Y �t-t 4 c�r+c�.t Y YI,Lc I� d-f�, 5'�ra,.e_ Ste ) V <br /> lag=s f ,� <br /> Y C s COL- z,c:'C4--te r <br /> V-1 !A. <br /> — <br /> Item/Location Temperature Item J Location Temperature <br /> __............_ <br /> deo r � J <br /> GlAm bvr ,r P� -fr S cS�egm <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> [Exp. <br /> ame: ilen �� Hand Sink: of Chlorine: ppm Heat: of <br /> Da e: _ _ are ashing Sink: �,r-y of Quat.Amm.: �G ppm Other: of <br /> Received By/Title: <br /> EH Specialist: Phone: 6 <br /> Time in: Time Out: J SO PagGPof 2 <br /> EHD 16-24 (2n1 pg) 4/3/13 / FOOD PROGRAM OIR CONTINUATION <br />