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SAN JOAQUIN COU16 <br /> a ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • �;.. ; Telephone: (209)468-3420 Fax: (209)464-0138 Web:www.sigov.oM/ehd <br /> claoaa <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: LC Date: <br /> ddress: 1-z 5 City: Zip Code: <br /> Owner/Operator: Telephone: 5a q _y <br /> Program Element: b� Program Record: S�Z �� Inspection Type: J <br /> 6m Posted ❑Yes ❑ Permit Posted ❑Yes ❑1 Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> - { <br /> \ ti <br /> I <br /> V <br /> vJ' �00 CJCQA 2 C <br /> Item/Location Temperature Item I Location Temperature <br /> C 1A �- <br /> 2 <br /> k(CLA <br /> zbr <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: t� aF hlorine: ppm Heat: "F <br /> Exp.Date: Warewashing Sink: `,L "F uat.Amm.: ppm they aF <br /> Received By I Title:' <br /> EH Specialist: Phone: U <br /> Time in: '. Time Out: -'`•���3� Pag of <br /> J 2• �.S <br /> EHD 16.24 12"pg) 413113 FOOD PROGRAM OIR CONTINUATION <br />