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(40'D <br /> SAN JOAQUIN COUN' <br /> ✓ �./ <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax.,(209)464-0138 Web:www.sagov.org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: p , / 4 el Date: $_ Z b _ <br /> Address: O r # City: Zip Code: Ct IcT <br /> wner/Operator: A C M tc-Qh If, f^+ Telephone: <br /> Program Element: j (.0 / Program Record: k00 3 Inspection Type: F " <br /> B180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> rj42.�t �l LQr^ S CpAec. LO . S n <br /> ►� IC' �, ' S.;hk <br /> nna f <br /> �' (�( \ _2PS nuc ole 1i� dlRr rc�S <br /> d s .rf-c 40,4-� f'c Ota ktred c-,'11 <br /> N a <br /> 2 r t s zr jraje/- (RQc'4--1n <br /> 25 - cc) < e r_s s k�e- -f'Z'jm Ckr-e <br /> Item/Location ,. , Temperature itemd Location <br /> WiCk <br /> Food Safety Certification Facility Hot Water Temperature - Warewashing 's <br /> Name: Hand Sink: U `t "F Chlorine: PqMM011 <br /> eat: of <br /> Exp.Date: arewashing Sink: Z _il.F Ouat.Amn Pther: -F <br /> ESpecialist: <br /> Phone: � ^7j �(�j' ! c3c) <br /> Time Out: Z ;CJ O Page/of <br /> EHD 16-24 (2n°pg) 413113 FOOD PROGRAM OIR CONTINUATION <br />