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SAN JOAQUIN COUK <br /> �.•'�t'•.OG <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> . c... _ Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.sigov.org/ehd <br /> '�c,FORa <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: ` Li Date: <br /> Address: Bc City: Zip Code: <br /> Owner/Operator: t LAU* Telephone: <br /> Program Element: Progra Record: ) Inspection Type: Walt <br /> SB180 Posted Yes No Permit Posted Yes No L Re-Inspection on or After: <br /> N <br /> �O <br /> l <br /> ►I N a <br /> 2 • <br /> cwu- 6L.L-,piaq <br /> -in 4�5 <br /> 0 V_ <br /> Oppayl <br /> yplk wkvn w Yi AnAlv K <br /> v <br /> M ewe Y - <br /> __ <br /> tt' Tnp'e Item I Location <br /> Food Safety Certificatk>n Facility Ho#Water Temperature Warewashing <br /> Name: 'Hand Sink: `F (Chlorine: PPm (Heat: F <br /> Exp.Date: arewashing Sink: °F IiQuat. Amm.: ppm Other: of <br /> I <br /> Received By/Titl . <br /> � r <br /> EH Specialist: Phone: <br /> Time in: Time Out: , Pag of C <br /> I/ J <br /> EHD 16-24 (2^d pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />