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SAN JOAQUIN CC TY <br /> .Z� ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95245-6232 <br /> • ��.. a;� Telephone:(209) 46&3420 Fax:(209) 464-0138 Web:www.siaov,ora/ehd <br /> ��FOA <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: e Lo 4)uri <br /> Ll tyk f`-4/I `�� r� Date: !�— �' <br /> Address: ry% t_, ,,� City: Ma n4e ccL Zip Code: <br /> Owner/Operator: r .�C GI nA S r r Telephone: <br /> Program Element: r_ Program Record: 2 0 rJ D 7J 2-7 6 Inspection Type:— <br /> SBf 80 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> h G(JcI G ` /d J+c <br /> r v�i L <br /> �/- zp•� �� a�f /�' � resins C, <br /> eI. t�-e� rP �i~o'7z1Z 3 A ) f <br /> - C - <br /> l <10 or <br /> ItemlLocation Semperature Item/Location ; Temper ure <br /> Food Safety Certification Facility Hot Water Temperature 4yarewashing <br /> Name: Hand Sink: "F Chlorine: ppm Heat: °F <br /> Exp.Date: arewashing Sink: `F !Quat.Amm.: ppm then. -F <br /> Received By 1 Title: <br /> EH Specialist: Phone: ` <br /> Time in: Time Out: I Page of <br /> EHD 16-24 (2' pg) 4013 FOOD PROGRAM OIR CONTINUATION <br />