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SAN JOAQUIN COUNfr` ' <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> Telephone:(209) 468-3420 Fax:(209)464-0138 Web:www.sogov.org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: d I <br /> I� 7177, Date: <br /> Address: ( cd ` I (h L J ' fCity: N t Zip Code: <br /> Owner/Operator: J Telephone: - 3 �J_ 7 (16 <br /> Program Element: Program Record: Inspection Type: C,4 n e <br /> B180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> O <br /> A <br /> l A /c � • r' h � C v <br /> oor rk c o ; / -u a ! c4acrYl. <br /> � u .4Sc W . f t: C a F G re <br /> r-u <br /> Nod' - <br /> Name: Hand Sink: =F hlorine: ppm eat: of <br /> Exp.Date: arewashing Sink: �1/ 'F uat.Amm.: ppm ther: eP <br /> Received By I Title: <br /> EH Specialist: Phone: <br /> Time In: Time Out: page20f Z <br /> EHD16.24 (2-pg) 11/2/9 FOOD PROGRAM OIR OONTINUATION <br />