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"a".'" SAN JOAQUIN Cour_ <br /> 'o .. . ......c <br /> 4 ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> �4..., •.�;;p Telephone:(209) 468-3420 Fax:(209)464-0138 Web:www.sigov.org/ehd <br /> LIFOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: L t h u ct 0-y Date: / <br /> Address: 7 S ` City: S K n Zip Code: 9 5 Z e b <br /> Owner/Operator: Telephone: u 7/- ,FU6 <br /> Program Element: Program Record: Inspection Type: / . e <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> W................_......__.... Yo(u „g h l a 4cj 001d (0 54 y <br /> 11A 112; <br /> �u -Ic�oc,� �'v►anq9 er S 4.�d <br /> C r oh S: e. <br /> l ati Ad Wr, 4e 4 <br /> yr0 ba&-e / Cc, rkec l e, <br /> 4 rav: Ye S 4 n : Ji Z e, I r } S 4".'02S irl Wee <br /> C"' a / 19 6 / <br /> ltem[Location i Temperature i Item I Location Temperature <br /> - -- s �r�.y► ate, h <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> ........................--`W _ <br /> Name: Hand Sink: °F Chlorine: ppm Heat: F <br /> Exp.Date: Warewashing Sink: , of Ouat.Amm.: PPM (Other: of <br /> 1� <br /> Received By/Title: <br /> W � <br /> EH Specialist: Phone: ( v/6� <br /> Time in: ; 107- Time Out: p; Page f <br /> EHD 16-24 (2n°pg) 4/3/13 / FOOD PROGRAM OIR CONTINUATION <br />