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SAN JOAQUIN COUNTT <br /> a` ?� ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> c9.,,�. ....�a• Telephone: (209) 468-3420 Fax:(209) 464-0138 Web:WWW.Si oy.Orq/ehd <br /> G/FOR? <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: o a (A r rA f Date: I?q- I_ / <br /> Address: I k „) 4 W. ( I I' 5+ City: v" c Zip Code: 1 5 C <br /> Owner/Operator: Telephone: T 35 y Sn0 u <br /> Program Element: Program Record: Inspection Type: <br /> c I ✓� <br /> SB180 Posted 0 Yes a No Permit Posted Yes No Re-Inspection on or After: <br /> TIVE ACTIONS <br /> ay�1r� I <br /> L 401' 1 �c <br /> G1CCr - <br /> r ICeS We l c I <br /> 04� L A 1\ �1c1n f, c } d 11 : n <br /> On 16 ve <br /> iC'rZCr - OG C r:nC <br /> J lu 3 <br /> Name: ;cif <br /> Hand Sink: OU °F hlorine: i 1 ppm eat: �(c °F <br /> Exp.Date: _ q / Narewashing Sink: / °F rust Amm.:V ppm her: °F <br /> Received By/Title: <br /> H Specialist: - Ph ne: <br /> Time in: I ,1 t Time Out: , 9 3 Page hof <br /> . <br /> EHD 1624 (2WPg) 11/20 J FOOD PROGRAM DIP CONTINUATION <br />