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SAN JOAQUIN COL,.rY <br /> ?a ENVIRONMENTAL HEALTH DEPARTMENT <br /> i 868 East Hazelton Avenue, Stockton, CA 95205-62 <br /> 32 <br /> Telephone:(209) 466-3420 Fax:(209}464-0138 Web:www.s ov.org/ehd <br /> �1 pOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> {/ - Date: <br /> Name of Facility: 01r t� n Zi�ho Code: <br /> Address: -rrr[ 1� shy <br /> r � ' TeOwner/Operator: �r. rr �� 3`�03 <br /> Program Record: lnsp cfi n T f_ <br /> Program Element: /�D! , 9 6R D(� $`] <br /> Bt80 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> {flBSt-AVJ lClVS AND CO1 fvCTIVI ACTIDN' <br /> 4Z 644 IW� <br /> -- GO rrt S -� C r,'/� A7 <br /> r .e or r ae <br /> liernlL odatiorj .- temper afore {tem 7 Location: TerripQrature <br /> Food'Saf ety Certification i*acdrtyrHot wgtet Tem�serature Warevrasi>Ing <br /> Name: Hand Sink: of Chlorine: PPM Heat: of <br /> Exp.Elate: arewashing Sink: of Quat.Amm.: PPM ther: of <br /> Received By/Title: <br /> c <br /> EH Specialist: f_ _ /J /_ Phone: 2/� <br /> ime in: /a .b� v�✓J Time Out: �, �� Page of <br /> EHD 1624 (21'pg) 4013 FOOD PROGRAM OIR CONTINUATION <br />