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SAN rJOAQUIN COOK .,.f <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.si(lov.org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: A Date: <br /> Address: C-u 1 r City. �. Zip Code: 9 51-;6caner/Operator: 0 Telephone: 3"j Ll - I b y / <br /> Program Element: Program Record: Inspection Type: <br /> C 1%nC <br /> 8780 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> 11 Ce 1 •w n . V)a IK-:n r• 1 0021 <br /> tG p <br /> SG <br /> 0; I.,ze #1G A So ccleecfrol <br /> uba.i a dd� l Pic - 17 ac -) <br /> Q i 1 •1' wr, IV'; �r <br /> od Safety Certification . , Facility Hot Water Temperat7-Fuat <br /> _Warewashing --' <br /> Name: Hand Sink: hlorine: ppm Heat: 'F <br /> Exp.Date: 1 1,1 / 7 Warewashing Sink: ` .Amm.: ppm Other. 'F <br /> [EH <br /> eceived By/Title: (� - h <br /> Specialist: Phone: <br /> ime in: ' (� Time Out: .1' Pegg of <br /> EHD 1624 (2b pg) 4IN13 FOOD PROGRAM OIR CONTINUATION <br />