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SAN JOAQUIN COUD <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> a . <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> cq.. iP• <br /> Telephone:(209) 468-3420 Fax:(209)464-0138 Web:www.sigov.org/ehd <br /> CjF�RN <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: a Date: e)O <br /> Address: WV wood <br /> ►, 011 City: ' t Zip Code: 5 2 <br /> Owner/Operator: 1"'V, Telephone: 5040_?_rD 11 <br /> Program Eleme 1 (0.2_3 Program Reco • `1 I G Inspection Type: <br /> B180 Post. Yes No Permit Posted yes No Re-inspection on or After: <br /> jj�<m y S AND CORRECT <br /> Poor 9nY- yndOrmeath cmc cc, dor n <br /> R n in r,e v- D a z 1 n d <br /> �-F#�� cui-r -FrQ2 iTnM cm in vP. <br /> %A00" c�4 -sVOWW en Kstrum nw-c <br /> ckmd fi 1 - <br /> f i n.¢ �.aAMd . C n a . <br /> 5 v M(Ahaolgvs. Sa Q2 tai c i S 001 ced <br /> d P* i G <br /> O inl cmk G s dod kwi e ihk+.& co <br /> MN 1(w UT\ reVG& C3T\ Sl+e. <br /> 2 r r 41" <br /> Food Safety Certification `:. . ' 'I <br /> Hot Water Temperature <br /> ame Hand Smk: `F Chlorine: ppm Heat: F <br /> Xp.Date: t( I-�/{ �� arewashing Sink: v 'F Oust. Arm.: ppm Other: of <br /> eceived By/Title / 1 <br /> EH Specialist: Phone: (�6Q f_ 6 <br /> ime in: 10 ,.(67 T 4 <br /> Time Out: 10 ; 0 1V PageZofL <br /> EHD 16-24 (2-pg) 4/3+13 FOOD PROGRAMOI COIJrINUA N <br />