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oRAgIK• �' SAN JOAQUIN COUNYT' <br /> 2` ? ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> +�iFoaa p. Telephone:(209) 468-3420 Fax:(209)464-0138 Web:www.sigov.org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: 2 Date: 6— 3:- 1 <br /> Address: o-, �5 a ` j ` \ - l�� S City 5� Zip Code: pl <br /> Owner/Operator: = `e ( qz� Telephone: <br /> Program Element: b2 Program Record: .5 c InspectionType: <br /> Bt 80 Posted C Yes ITNo Permit Posted T1Yes ❑ Nov Re-Inspection on or After: <br /> y 11 <br /> IIJ <br /> Name: Hand Sink: of hlorine: Ppm eat: -F <br /> Exp.Date: Warewashing Sink: eF uat.Amm.: PPM Other: 'F <br /> Received By/Title: <br /> EH Specialist: Pho^ : y Q — t�33 <br /> Time in; t2 c Time Out: \'.O2- PaAoff <br /> EHD 15-24 (2-pg) 1`1/2109 ...7FOOD PROGRAM OR CONTINUATION <br /> S-\,, tvs�c.� 2C) - bt32�o 'S Q4% <br />