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oaau'" SAN JOAQUIN COU Y <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • c... ip• Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.slgov.org/ehd <br /> 4tjF�Ri� <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: ✓l LO6 U n,L,-ri 4q r Date: LI-1-?_) 3 <br /> Address: 1609 <br /> p) t L1 L City: O C.K-tDo Zip Code: 9 5;LQ 7 <br /> Owner/Operator: j__ Telephone: _ 2 <br /> Program Element: I�3;2_ Program Record: p R OI��3 Inspection TypetLnd�Ov�fhQ.� <br /> SB180 Posted Yes No Permit Postedy Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> Y7 a r0 u» <br /> 15 <br /> YnO w CA-4 r C=5 do rn rzz <br /> 1 r -P` ; <br /> c1 .1 Cc r <br /> Item/Location Temperature Item/Location Temperature Item/Location Temperature <br /> L&d 12 K 4- . c j r Y�te�lSe I <br /> Scor h►o�d�- 3� F - - <br /> Foo afety Certification Facility Hot Water Temperature W,arewashing <br /> Name: Hand Sink: %3D o f Chl i G4 C��L-e- ppm Heat: o f <br /> Exp.Da e: Warewashing Sink: of Qual.Amm.: �. ppm Other: of <br /> Received By/Title: <br /> EH Specialist: Phone: L _,? J� <br /> Time in: f D' O Time Out: I .4D Pag5 of <br /> EHD 16-24 (2°d pg) 4/9/12 {{ FOOD PROGRAM OIR CONTINUATION <br />