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a a` '" SAN JOAQUIN COUNTY <br /> W. . X <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> :'. 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(249) 468-3420 Fax:(209) 464-0138 Web:www.segov.org/ehd <br /> Likd'is`' <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: s _ { _ Date: <br /> Address: N C E tR L� A City: 7-p Xi C Zip Code: <br /> Owner/Operator: Telephone: <br /> Program Element: r t'B uha,prograrn Record: 1 O 1 ( inspection Type: <br /> 8180 Posted Yes No I Permit Posted Yes No 1 Re-Inspection an or After: <br /> $ERVATIONS AND'CORRECTIVE ACTIONS <br /> A <br /> �^•� ej r <br /> z. <br /> `z dSI v► ►�-c <br /> C� l <br /> i1 <br /> Y <br /> .p oil ✓' <br /> w <br /> ASA <br /> fl i� <br /> o v -✓ <br /> � 14 <br /> /C r <br /> w <br /> 17 46 /Dff <br /> 6may.^ rr >/ ' t� ice. <br /> mi6tem/L em .,.n,tum Item/LocationS impdrature <br /> 12 <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: F Chlorine: ppm Heat: 'F <br /> Exp. Date: Warewashing Sink: F Quat. Amm.: ppm Other: "F <br /> Received By/Title: <br /> EH Specialist: Phone: <br /> Time in: / �' ^ — 117 iFY Time Out: L^ Page14 lofY <br /> EHD 16-24 (21 pg) 413113 +"i' ,if FOOD PROGRAM OIR CONTINUATION <br />