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SAN JOAQUIN COUrv-(Y <br /> q ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> a4�/FBd�,e Telephone:(209) 468-3420 Fax:(209)464-0138 Web:www.sigoy.or0/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: L c4 5 Pr r 1&5 d'q W Date: //-/0-/ c/ <br /> Address: 17 11 S. <br /> City: ; )1 Zip Code: 95.20,- <br /> Owner/Operator: <br /> .2vCOwner/Operator: Telephone: 14; <br /> Program Element: Program Record: Inspection Type: <br /> J <br /> 8180 Posted 0 Yes O No Permit Posted O Yes 0 No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> L; 1 W 30G23 <br /> y h . /'2ac�' <br /> rcv: th -ss ler l.7 ;r S. n :C"'X <br /> r-rkrocIl' l cor/u <br /> rrv:prF. G t. In ! rnll <br /> 3 <br /> pro v: dr 3PIl deee : n LdPnK. <br /> O' Y. Q trm i- ( S CAI c( t PS am A '-o% <br /> Item/Location Temperature Item/Location Temperature <br /> r t,c ►.. ;r. y(r° 5 �orn,n {Ah re <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Of and Sink: /OG A -F Chlorine: PPM eat: 'F <br /> Exp.Date: / _ arewashing Sink: I 'F Oust.Amm.: PPM ther: -F <br /> Received By/Title: <br /> EH Specialist: _ Phone: . 316)- <br /> (/ <br /> Time in: �2 Time Out: y .33 Pagvf <br /> EHD 1624 )2-Pg) 41Y13 FOOD PROGRAM OIR CONTINUATION <br />