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4PIN" t SAN J4AQUIN COI�,�Y <br /> Q: . X <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax: (209)464-0138 Web:www.s ov.org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Per <br /> Date: <br /> Address: 1P I I lr� r City: is Zip Code: <br /> Owner/Operator: LA 1/ rv-c Telephone: 0 3_.;ILOb <br /> Program Element: 1/_Q d Program Record: GO d0 Inspection Type:} <br /> SB180 Posted 0 Yels``PP0 No Permit Posted ©Yes 0 No Re-Inspection on or After: <br /> f o <br /> 0191.1 :3 Co - tom'•a 4-qnt ua�e ha.s�_d ck✓i 1-e w <br /> mocd &'i i+. <br /> do vt Ge r n.t d <br /> rLou -e r A 8,nA caYL� <br /> c -ter <br /> 7YzA <br /> r V-nAe- r r-e- cam` zP rr . `rk- <br /> OA ner� cz"i i r�-h�ort <br /> +n ►-� --x CL Y- -hal <br /> d 0,Wre <br /> � 01LA <br /> r-e- CL a <br /> 92 <br /> mood o <br /> 1tem71 sa..... _ort:, e eratur r,, Beni?`ic# t�ora a;gempetatu!e <br /> _.. <br /> Eaod afet ,der rcaEian �' rfiiy ds3 rT erre, Nfare cashing <br /> Name: Hand Sink: foFChlorine: ppm Heat: -F <br /> Exp.Date: Warewashing Sink: / 'F uat.Amm.: ppm Other: `F <br /> Receivred By/Title: <br /> EH Specialist: Phone: 3 -2? 1--7 <br /> ime in: Ti <br /> odme Out: f / Page of r <br /> L <br /> EHD 1&24 (2n°pg) 4!3113 FOOD PROGRAM OIR CONTINUATION <br />