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SAN JOAQUIN COV ' <br /> Q` ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.sioov.org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: L ZZ, Date: ' O n <br /> Address: 1 2-!t) ( `( City: StDU�_tZ7rj Zip Code: Oil c510S <br /> Owner/Operator. ti Y�/T 0 M V 1_ Telephone: <br /> Program Element: I Program Record: �w15 �6G.f= Inspection Type: �-W-1[:.f t-f.� <br /> B180 Posted Yes No Permit Posted Yes No .�.J Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> P S of jqu hies 1OLK I z S . rr i.T)G�u-Ftcc has-- <br /> nGl �n CeCAI)00 1 , <br /> 1� pY-- DZ>due nn�rm�� -`�Cr 2U1�- <br />' - <br /> Item/Loca ion Temperature Item/Location Temperature <br /> Food Safety Certification Facility Hot Water_Temperature Warewashing <br /> Name: Hand Sink: ofChlorine: ppm eat: of <br /> Exp.Date: arewashing Sink: of Quat.Amm.: ppm ther: of <br /> Received By/Title: I (;-N 1 (N <br /> EH Specialist: Phone: <br /> Time in: ' O; Time Out: 1p: lig "t Pagel of <br /> EHD 1624 (2n°pg) 4/113 FOOD PROGRAM,0IR CONTINUATION <br />