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�Q,DA® @,FA4 SAN JOAQUIN COUNu <br /> r ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> .. P, Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.sigov.org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: ,t C r _�' / n Date: <br /> ddress: 1 S 9 In city Tri c zip code: yS-776 <br /> wner/Operator: Telephone: <br /> Program Element: Program Record: Inspection Type: CNS <br /> 8180 Posted Yes it No Permit Posted Yes No Re-Inspection on or After: <br /> IIIIIIIIIIIE— <br /> VATIONS AND CORRECTIVE ACTIONS <br /> I r1 I ; l �u Il ali <br /> c' <br /> 7n I ! n <br /> r <br /> S PIP a r <br /> nC, r cl o <br /> rc rvl 1, 1C 0 C rvc { . .IYr <br /> n + i <br /> fern 1•n { h iC -T <br /> Medretil V. Cly F LOrr. , 1 <br /> Ks. <br /> 4 de fells e , S F O J l 11 II <br /> ye allow'sh Idj P Pit Tern ac . I; I <br /> PL la be1 1 Se 1` Serve c. e q <br /> ING dr: is Aa r✓l7 v rc <br /> h to u be I ^C /4 661 W C rjrrp,1 in' <br /> Ld eo ll <br /> djc ; A I ai ar it ve C" 43 r2if 4; nle ® <br /> a <br /> vi. )I a I, a r e <br /> aci <br /> Name FoO�u` ..tiNon __ — _. Harewashin Hot Temperature F Chlorine: <br /> wPP'^a O[h e. /6 =oF::: <br /> Exp.Date. C i } 4 9 F PPM °F <br /> Received By/Title: <br /> H Specialist: Pho' . Z 6 ,P- Ai� <br /> line in: U v Time Out: ;) Page of.. <br /> EHD 16-24 (2°'pg) <br /> ��4yy/,3�113/3�� v , FOOD PROGRAM OIR CONTINUATION <br /> Nd)c , /l/1C9k�C SU /o 1.yI11S Prop Clfell Grr Sha. �irr�li. l <br />