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SAN JOAQUIN COUN'i <br /> X ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • ,' ;P• Telephone: (209) 468-3420 Fax: (209)464-0138 Web:www.sigov.org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: C �( Date: L(Z J <br /> Address: t V\(X VvLLl a*,Lc City: Zip Code: <br /> Owner/Operator: Lt�t-n(- 6,/ r Telephone: <br /> 1•C <br /> Program Element: I s ' Program /'W V Record: i 1-il D 2 G tri(J F Inspection Type: �t <br /> B180 Posted ❑Yes ❑ Rermit Posted El YJes I El Re-Inspection on or After: Is <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> OILv v v A - � J J (Iy, _�S'f - r <br /> CO- k dAA ca'q <br /> Lia 0(A c, <br /> LV4 J-4 <br /> Air IIIylWdAIL(�f <br /> S`•PF ' <br /> i y4a <br /> Caw , <br /> ww. <br /> -.vr- vl <br /> rtw\.,,✓m _VVVJ' �, vL <br /> - c �' <br /> 9� yo C <br /> k <br /> W vvV14" V" <br /> Item/Location Te` <br /> l'1 /✓��itim,w -4,( w Get: 'j <br /> 77 <br /> Food Safety CertificationFacility Hot Water Temperature Warewashing <br /> d- <br /> Name: Hand Sink: of hlorine: ppm Heat: of <br /> Exp. Date: Warewashing Sink: of Quat.Amm.: ppm Other: of <br /> Received By/Title: ic <br /> EH Specialist: Phone: LfOLMu <br /> ime in: Time Out: Page Z <br /> EHD 16-24(2nd pg) 413/13 FOOD PROGRAM OIR CONTINUATION <br />