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SAN JOAQUIN COUN , Y <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> �q.. . .a;P• Telephone:(209)468-3420 Fax: (209)464-0138 Web:www.sugov.org/ehd <br /> ��FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: e e: <br /> e Y70 rS DatI�1-1 Z <br /> Address: City:Iq LAJ Gt rch LA KL.c_ City: 5,�e lm,.-7 Zip Code: G} SZ 9 <br /> Owner/Operator: l lot r L. -r- 12-a �l Telephone: 01 3 3 <br /> Z <br /> 39 <br /> Program Element: I(to 6 �f uProgram Record: P Q of 4)- Inspection Type: fzL I tri <br /> SB180 Posted Yes ❑ No Permit Posted'%Yes ❑ No Re-Inspection on or After: <br /> -OBSERVATIONS AND CORRECTIVE ACTIONS <br /> 5 11 YS L-eD U C.cz r O r <br /> Cg;"-b l-A- , �-e - s <br /> -lameK Vr ' 4)1. <br /> r>°aA-r-� <br /> Item/Location Temperature Item/Location Temperature Item/Location Temperature <br /> a�80 y-Cay Le r F <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hind Sink: of Chlorine: ppm Heat: of <br /> Exp.Date: rewashing Sink: of Quat.Amm.: ppm Other: of <br /> I- A <br /> Received By/Title: l <br /> EH Specialist: i Phone: 6 <br /> c �J <br /> Time in: , ' . d Time Out: u GPage hof ' <br /> l �5 <br /> EHD 16-24 (21d pg) 4/9/12 FOOD PROGRAM OIR CONTINUATION <br />