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e�p'n• SAN JOAQUIN COURrY <br /> ?� ENVIRONMENTAL HEALTH DEPARTMENT CSP i_ <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> ' Telephone:(209)468-3420 Fax: (209) 464-0138 Web:www.sigov.orq/ehd LEA(C` 1 <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: \ �e Iy\ Date: <br /> Address: City: Zip Code: cf 5 33 <br /> Owner/Operator: S IIN Telephone: 23 '122 <br /> Program Element• 4 ` �2 Program Record: 51 -23-4-11 ko322 Inspection TypeTQ <br /> SB 180 Posted ❑Yes ❑ o Permit Posted [I Yes ❑No Re-Inspection on or After: <br /> 1C.6 <br /> PtAv'j <br /> - +^0 IF - A-3 101 P <br /> uI �-- VaQ_Lu <br /> Rem/Location Temperature Item Location Temperature <br /> 13b <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: of Chlorine: ppm Heat: of <br /> xp.Date: arewashing Sink: of Ouat.Amm.: ppm Other: iF <br /> Received By/Title: !. . �� nr leS . O <br /> H Specialis • t�! Phone: y'016- 7 <Z)1 <br /> Time in: _' Time Out e , Page-,pf 2 <br /> EHD 16,24 (2m p9)4/3113 c� FOODPROGRAMOIRGONTINNUA110N <br />