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o�qu1!x, SAN JOAQUIN COUN, <br /> 2' ,z ENVIRONMENTAL HEALTH DEPARTMENT <br /> a: a <br /> m: < <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-623 <br /> Telephone: (209)468-3420 Fax:(209) 464-0138 Web:www.s ov.org/ehd <br /> {rFo>a <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: 12 1w Date: �2- k� <br /> 01V 17�.ti �1-Y�LC Y S O Zip Code: G�2Ga <br /> Address: ��L1 � Sfi Cit ' n <br /> Owner/Operator: mat l an Telephone: <br /> rojg:ram0­­­61L Element- �N�o <br /> Program Record: U .0Inspection Type: V_rkl <br /> Psted Yes Permit Posted Yes No Re-Inspection on or After: <br /> +DB RV 1TIONS AND CQ tREC t11E,ACT[ ) IS <br /> WIA Je .0-61�. nsl a,An VIC)1 x- Cin tcyjCt - <br /> C1+i n t '1()G i a <br /> Cm rr �Val�_h pefMk t - nc*_. M a-_ _ -- <br /> 9MICAAP-0 CA y6_nc112-f owd -vo(a q der do <br /> 100 S I nS cqoiC r cx tk" cm S I+e- <br /> - <br /> itemlLocatfo� " Tem ., atureItem4 Location, Temperature <br /> NG <br /> i=ood Safety Certification Fa.ciljty Hot:Water'Ternparature Warewashing <br /> Name: Hand Sink: UC) OF Chlorine: ppm Heat: aF <br /> L <br /> Exp.Date: arewashing Sink: l2! of uat.Amm.: � ± ` ppm ther: of <br /> n_ <br /> Received By it <br /> EH Specialist: Phone: <br /> Time in: 3� .2 Time Out: b Page2_0f2 <br /> EHD 16-24 (2^d pg) 413!13 FOOD PROGRAM OIR GONTINUATION <br />