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SAN JOAQUIN COUt)r <br /> ENVIRONMENTAL HEALTH DEPARTMENT Ur-Q- 0 <br /> t <br /> .�. <br /> k n CA 95205-6232 <br /> East Hazelton Avenue Stockton,1868 t Stoc <br /> = r /ehd <br /> 138 Web:www.s• <br /> OV.O <br /> r•.-;♦ �•;..`a.• Telephone: {209) 468-3420 Fax; (209}464-0 19 _ q� <br /> 4 4�rFiia`a . <br /> I FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: G el ; ` Date: <br /> Address: 1-Z i � City: Zip Code: 3 <br /> OwnerlOperator: , 1 Telephone: [�,2_\ _ 0 b <br /> Program Element: l b2_ P ogram Recd : S 2—j Z b<D Inspection Type: <br /> 8180 Posted Yes ❑ Aermit Posted ❑Yes ❑ I Re-Inspection on or After: <br /> i te <br /> F80 POSC� <br /> I <br /> e J -S 2 c�Q 1 -S o. <br /> F - <br /> j `_1 1n o h <br /> &172 <br /> S ( rQ) 5`isz9 1 Jo.5. <br /> b _ s - r e 2 <br /> I ` <br /> �.�cat�., . ..r s m ,. ,���:..,q:.y...•.�;<ag' f� ���� "S4 �tLl�i <br /> . p.0 <br /> m <br /> I� <br /> e.em. <br /> cs <br /> R-aW'J 'u'�Od � 4TY11a �it <br /> Name: Hand Sink: 'F Chlorine- ppm Heat: 'F <br /> Exp.Date: Warewashing Sink: 'F Quat.Amm.: ppm then: of <br /> Received By 1 Title- <br /> �l�-G C.63Cc7 <br /> EH Specialist: 1 Phone: "4 b -- <br /> Time in: O Y` Time Out: �� 11-SPage of <br /> 1;2 <br /> EHD 16-24 (211"pg) 43113 FOOD PROGRAM OR CONTINUATION <br />