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4° n. SAN aJOAQUIN COUP <br /> °" . <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> ` 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> �.. P Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:AM-goy.or0/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> �� rr�� Date: <br /> 14 <br /> E <br /> y: g City: Ih( 2j) Zip Code: (1672 <br /> 7,5 �n <br /> C ^ �) Telephone: "Z— <br /> r: 'I U '11 �� <br /> Program Record: CC), <br /> Inspection Type: ( <br /> nt: i MCI g <br /> Yes No Permit Posted Yes No <br /> Re-Inspection on or After: <br /> "OBSERTIONS, iQ013REGT#YE ACTIONS <br /> nk o allvitN�ia� <br /> . - �n G <br /> petature <br /> Food Safety Certification ( Facility Hot Water Temperature ng <br /> _ _— <br /> Name Hand Smk: °F Chlonne: PPm Heat ,F <br /> Exp.Date: Warewashing Sink: -F Ouat.Amm.: PPm Other: <br /> Received By/Title: L <br /> EH Specialist: Phone° G _ _ 6 <br /> !me in: Time Out: cl <br /> . ,Sr Page of I <br /> EHD 1E24 (2n°Pg) 41y13 > FOOD PROGRAM OIR CONTINUATION <br />