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SAN JOAQUIN COUt. <br /> ' + ENVIRONMENTAL HEALTH DEPARTMENT <br /> x <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • �q.- a�P Telephone: (209) 468-3420 Fax: (209)464-0138 Web:www.sigov.org/ehd <br /> LIfOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: <br /> Address: I LI q(] — rQ CLO City: Lr Zip Code: C)62 OZ <br /> Owner/Operator: _1 7 v Telephone: <br /> Program Element: ' �Lf <br /> Program Record: /`/� (0.Z 39 2 Inspection Type: K <br /> B180 Posted Yes ❑ Rermit Posted Yes G t Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> b ©Y InJ 4v+-c_ C� -t'. ` e <br /> AY01 a in 4- w i S-e rh_, (-os cc�►n <br /> l ( C1-fr -}Orate e <br /> h rn.,° Lo D 0-L n ®r ce ve_�- <br /> 1-2 •)A_, , &:5 no Yke W Y- u_kx -e r- dram <br /> ci' a 4-e <br /> n d- I rL c 1 <br /> 1VGs -c f <br /> I rio bro c,oZ n -G -k KcL yat, - 0 L�r <br /> Item/Location W&catfon Te iperature <br /> 7 ------ <br /> Food Safety Certification Facility Hot Water Temperature <br /> Name: and Sink: aF Chlorine: ppm Heat: of <br /> Exp.Date: arewashing Sink: of Quat.Amm.: ppm Other: of <br /> Received By/Title: <br /> EH Specialist: 't"I_24 Phone: <br /> Time in: Time Out: 1 ,, /a Page of a <br /> EHD 16-24 (2ntl pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />