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ow <br /> SAN JOAQUIN COLyY <br /> ENWRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax: (209) 464-0138 Web:www.siaov.org/e <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: _ O.1 <br /> cg� "�s city: Lo zip code: 9 S 24O <br /> ddress: la / sbi . .f - ab9_g��0 <br /> Owner/Operator: r d�"f C.65�rTelephone://'7 �.Yn„`�!� I <br /> Program Element: Program Record: Ni 6 6190y Inspection Type: �u <br /> SB180 Posted es No Permit Posted yes ri No Re-Inspection on or Atter: <br /> N <br /> CTIVE ACTIONS ... <br /> tp?,4� <br /> .3.s i rr r7S('.> zd <br /> �K to e lls,�.t /Li:'.7 IvLLe.- <br /> a door n4_cam 37"7 rvo,14- l O <br /> lJowU', 1'r �fY T IqDF <br /> 7 tiy-rr*-C.e l o I <br /> `od Safe`.. ,.,_ Ot Facility Hot Water Temperatures--1 i; Warewashing <br /> ._ ____— —.- pp �I <br /> Name `� Hand Sink: l/V / //S °F r1/1 Wr�i Lr �Q(�pm Hssr rCJl�Gi /.2-:.F <br /> Exp.Date: _ _ t War hing S� /�� aF t.r inm.: L,1�ppm Other. aF <br /> � 7 A <br /> [EH <br /> eceived By/Title: <br /> Specialist: 6tL_f `yyyrf Phone: 953-?00J, <br /> ime in: Time Out: of Page e <br /> EHD 1624 (2b pg) UN13 V FOOD PROGRAM OR DONTNUATION <br />