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oe4�'I" SAN JOAQUIN COI' <br /> ENVIRONMENTAL HEALTH DlePARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • �q.. �;�� Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.sigoy.org/ehd <br /> �7F6'A <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: —L 1 ZZ Date: I01no 10 <br /> Address: ' 2-� ( City: S.1—nV <br /> i--, -I Zip Code: /JI 5uS <br /> Owner/Operator: i v. 1(^_ �I 1 ` V l_ Telephone: "1 <br /> Program Element: (� Program Record: �` v�15 Ly-O(7G� Inspection Type: L, <br /> N�J <br /> SB180 Posted Yes No Permit Posted s No Re-Inspection on or After: �1 <br /> Ye <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> r>d <br /> - <br /> Item/Loca ion Temperature Item I Location Temperature <br /> Food Safety Certification Facility Hot Water Temperature Warewa_shing <br /> Name: and Sink: 'F Chlorine: PPM Heat: 'F <br /> Exp.Date: arewashing Sink: `F uat.Amm.: PPM ther: 'F <br /> Received By/Title: _ f I - <br /> EH Specialist: Phone: rrA _ f _ h G <br /> Time in: 1 p; Time Out: c), 1� lL `i Pagel of <br /> EHD 1624 (2-pg) 4rN13 FOOD PROGRAM OR CONTINUATION <br />