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SAN JOAQUIN COL Y <br /> �+ ENVIRONMENTAL HEALTH DEPARTMENT <br /> X <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • •.. _ �a Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.s*gov.org/ehd <br /> 4CjFo'�e► <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: - , Y rr ) Date: <br /> Address: f_ /,fir 1 __ City: �L, �L1.�� Zip Code: C, �� <br /> Owner/Operator: —� ►^ �`oL C7 7 l� Telephone: ;L h <br /> Program Element: �• Program Record: Inspection Type: I <br /> SB180 Posted Yes F No Permit Posted _ Yes LiNo �J Re-Inspection on or After: f— <br /> l <br /> � _.. <br /> t IF too Y vi a,L4 Cif �-I k+ i cL#- Ge'C <br /> 10- 1 - 1 - 1Lt r . �1�u <br /> u W 3 e - <br /> W t, COS3 <br /> rj <br /> Item/Location Temperature Item/Location Temperature <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: of Chlorine: ppm Heat: of <br /> Exp.Date: Warewashing Sink: of Ouat.Amm.: ppm Other: of <br /> Received By/Title: <br /> EH Specialist: Clef J_ias lJ Phone: 63` <br /> Time in: /.1 <br /> 00 rTime Out: ;os Pagef <br /> EHD 16-24 (2nd pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />