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SAN JOAQUIN COU 'Y <br /> 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.slgov.org/ehd <br /> LIFORN <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: q 1 A f- -s- C4- } Date: to _i3_I <br /> Address: /_-L LA-) Yah r ,I e r l-'"1 City: +Q U<+I) n Zip Code: 0) 62-to <br /> Owner/Operator: 101 Telephone: -r) 3_ I o ' <br /> Program Element: t 15 Program Record: P R 05 <br /> 2 B-1 O Inspection Type: v +i <br /> SB180 Posted- Yes No Permit PostedD(Yes No Re Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> 0 Y VL oY m Ze-- L Iepi r <br /> L LS n o aA:o t 5 y r <br /> Yn.eo,n t,�►-�.� ve., U-slos-e k aCL+e <br /> Item/Location Temperature _ Item/Location Temperature <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: H Si` , of Chlorine: ppm Heat: of <br /> 5 Sy <br /> Exp.Date: Sink: of Quat.Amm.: ppm Other: of <br /> Received By/Title: <br /> EH Specialist: Phone: <br /> Time in: �Q Time Out: Page of <br /> EHD 16-24 (2nd pg) 4/313 FOOD PROGRAM OIR CONTINUATION <br />