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°"'" SAN JOAQUIN COUNTI <br /> �-� ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax: (209)464-0138 Web:www.s*gov.org/ehd <br /> <<FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: LA y V-L{ Date: -V/ 1 / I <br /> Address: CA <br /> ' City: S-1-s.r,..fG� Zip Code:Lq 6X s <br /> Owner/Operator: Tp1 C/- p ,AUT\C15 1 Telephone: 90-4 _q6j Ab <br /> Program Element: IJ ` Pro1Vg'ram Record: C)() 1[)�— Inspection Type: <br /> 6180 Posted ❑Yes ❑ Rermit Posted ❑Yes ❑1 Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> c? <br /> V P-W ok vood M unCk 'S food cp_x� cu i n (vG d <br /> MCI G _�Vo "rduf fir 1 n <br /> 3 O 0 C(Sj s C) Ir1I-- <br /> Th e 2 ox- C aA k p- ,S G t Cl `�- uSfi r ay- <br /> e <br /> ItTemperature ttertt 7 Location emperature <br /> ..... �. ___.�_ _. . _ <br /> d(- co <br /> AGM _._.. 1(P0 <br /> Ir <br /> Food Safety Certification Facility Mot Water Temperature Warewashing <br /> _ <br /> -- <br /> .. <br /> Name: :Hand Sink: jC)C) -F Chlorine: CA ppm Heat: �F <br /> Exp. Date: arewashing Sink: 'F uat.Amm.: ppm Other: `F <br /> Received By/Title: <br /> EH Specialist: Phone: �GC( <br /> Time in: n Time Out: `l 0 Pag <br /> ,Ire lof <br /> EHD 16-24 (21pg) 413/13 FOOD PROGRAM OR CONTINUATION <br />