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o.N't"'"• F mss' SAN JOAQUIN COUN%Y <br /> ?< ENVIRONMENTAL HEALTH DEPARTMENT <br /> r. < <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> d4c/Fd �;a Telephone:(209) 468-3420 Fax: (209) 464-0138 Web:www.siaov.org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: 5 (I ( t y C,&Aron } Date: <br /> ddress: so .( - + I 1 YG zip Code: s ? G <br /> wner/Operator: Telephone: <br /> Program Element: Program Record: Inspection Type: <br /> B1 80 Posted "'!Yes L i No Permit Posted n Yes n No Re-Inspection on or After: <br /> EMBSERVATIONS AND::- VE ACTIONS <br /> S or _ �, .. run , f- <br /> A :n hf) ltrr 1 O <br /> 1 <br /> -7C <br /> 1 <br /> la b P 112 f S too V1 lah�t. <br /> rin not, d / <br /> rep *u I 1a f" 10� �n <br /> On 4 cru <br /> 1r,jo nz yuntlioAi n a{ ha n <br /> S )< o C, 0(,& <br /> 1a <br /> I - h4 z K A 1!a r. Re a te yj aa le <br /> S lornd OW40446 S <br /> /3 bel W or, G <br /> rc cl . l 4064 <br /> •1. 1• - CG ' rn <br /> G <br /> Tt. •QO(Jr ►3GCK 41 CO liw t l rP ,.F <br /> 11:on. T } a aps,A. , Sac�rrlJAnlc <br /> rry cico rc,t} `�I Y <br /> Food Safety Certification , ility Hot Water Temperature i <c 1, __Warewashing <br /> Name Hand Sink: 'F Chlorine: a ppm Heat: eF <br /> Exp.Date: Warewash ing Sink: I :.F Ouat.Amm.: PPM they: eF <br /> ESpeci]allst: <br /> itle: t,•-\ <br /> - Phone: 6�. J��Time Out: :1Pa]geoT] <br /> EHD 1624 (2n°pg) 4/3n3 FOOD PROGRAM OR CONTINUATION <br />