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P4L'" SAN JOAQUIN COU f <br /> �-� ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> c9c/Fd,RN;p Telephone: (209) 468-3420 Fax: (209) 464-0138 Web:www.sigov.orq/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: L-*- <br /> Date: •� _1 _1 <br /> Address: 10 9 I O „u �r L City: +0C�+0ki Zip Code: L95 <br /> Owner/Operator: L.I.I-SD Telephone: 2 <br /> Program Element: I�. Program Record: PA 01400360 Inspection Type: 2nd 12-oo4i rte <br /> K8-0posted es ❑ Permit Posted Yes ❑1 Re-inspection on or After: <br /> s� OBSERVATIONSAND CORRECTIVE ACTIONS . <br /> 045' <br /> r C tih % -1e r <br /> Temperature ,� Item!Location i Temperature <br /> Coo Ce r H L ur ?ted-Crux ��'�1l 5 n L <br /> M( HL (Q r 3� r <br /> is coryjCi rr f_ r n7'F11 <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: 1� Y ✓�i-LI N Ci /. �Z i Hand Sink: `r of C-1�erifleT t. pm Heat: of <br /> Exp.Date: _ I arewashing Sink: S <br /> -__ <br /> o uat.Amm.: pp Other: ,F <br /> 1 F -GOY,. fi 4 m <br /> Received By/Titl <br /> EH Specialist: Phone: 015 `7119 <br /> Time in: I Q:[ +0 Time Out: Z Page.0 Z <br /> EHD 16.24(2'd pg) 4/3/13 FOOD PROGRAM OR CONTINUATION <br />