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SAN JOAQUIN COUKf <br /> Q' 2 <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> - 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209)468-3420 Fax.,(209)464-0138 Web:www.siciov.org/ehci <br /> tiaua`' <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> E <br /> : _< i� - 4- ! Date: <br /> �, /tti City: r�( ZipCode: /Z' /_/9JJ >74 <br /> Telephonet: Program Record: Inspection Type: <br /> Yes I' No Permit Posted 0 Yes 0 No Re-Inspection on or After: <br /> rcrt r4ri i Ii ?-,Fr ! WA.) fr: '-N 2 le <br /> 1 1.; a l r er a 1 r , ! <br /> OGr 1 ; 1t3 dG W P ' 4 /! i <br /> 4 IWO bN <� <br /> Slff le . n i n / L " <br /> Tvucn L39 r Ivu� 3 <br /> • -... .. d Safety Cert ion _ Facility Hot A emperature <br /> Name Hand Sink: "F Chlorine: ppm eat: F <br /> Exp.Date: i „I Warewashing Sink: `F Ouat.Amm.: ppm ther: eF <br /> Received By/Title: .. <br /> EH Specialist: - Phone: 6d-"J16 <br /> ime in: / d Time Out: Pag;f <br /> EHD 16-24 (2n P9) 413113 FOOD PROGRAM OIR CONTINUATION <br />