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oP41`" SAN JOAQUIN COU, t <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.si4ov.orq/ehd <br /> ��FORt� <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: LLia Date: <br /> I <br /> Address: City: Zip Code: <br /> Owner/Operator: C G 00 4 r CJ27n Telephone:920 <br /> Program Element: Program Record: L 0cc) 7_7�q+ C00-, 4 212- G Inspection Type: <br /> S131 80 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> CcpGini- gzA •, y , cek\ioq cn CAn <br /> un ermicat-A­ <br /> -0 <br /> at-A--v r-O C4l i Goo -r CA unpexTnitAW TWO CcAr� <br /> ID1 S nnue_ Fro c-4iee -t-v cm r ne <br /> n CI . d 1TA cn c.K <br /> yefn-f�.ek vor0 c/r pacred CC) c cc r::- OrCA <br /> 17�Scun� nu.eG u <br /> �.RemJLocation� Temperature F 2, Item f Location Temperature <br /> Food Safety Certification _Facility Hot Water Temperature Warewashing <br /> Name: HandSink: of Chlorine: ppm (Heat: of <br /> Exp. Date: Warewashing Sink: of ouat.Amm.: ppm other: of <br /> Received By/Title: <br /> EH Specialist: C Phone: <br /> Time in: I : n Time Out: Page �of <br /> EHD 16-24 (2n1 pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />