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SAN JOAQUIN COUNT <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.sioov.org/ehd <br /> �rFOr�� <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: P�;�K I Date: G(,-2— .—/3 <br /> Address: Yos— City: - 1 Zip Code: g�Z) <br /> Owner/Operator: L_ f c �O Telephone: <br /> Program Element: /L32 <br /> 32 Program Record: 6 p`O �� Inspection Type: <br /> B180 Posted ^as i No Permit Posted Yes C. No Re-Inspection on or After: <br /> c r 6 <br /> (t6.S 4 <br /> S . Qv- k¢.!� a <br /> 7e <br /> 5Q K•'F�oa� �wctc@ - W� <br /> M'4-9 O <br /> Food Safety Certification _:" tty Hot Water-Temp Warewashin` <br /> Name. Ai <br /> q" M and Sink: / .� •F Chlorine: PPM jHeat: of <br /> Exp.Date: j-7 arewashing Sink. i 3 of uat.Amm.: ppm Other: of <br /> Received By/Title: <br /> EH Specialist: Phone: <br /> ime in: Time Out: I - Z Page of Z <br /> EHD 1&24 (2n°pg) 4IN13 FOOD PROGRAM OF CONTINUATION <br />