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SAN .JOAQUIN COUP <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.sigov.org/ehd <br /> �r FORa <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: — 1 Date: _-4 <br /> Address: City: / Zip Code: <br /> S, � �"�'Y1 C /1 C/�/104S 2 -7/ <br /> Owner/Operator: 16' a : ^ I Telephone: 9r3- <br /> 7 4 <br /> Program Element: 7 Program Record: /d Inspection Type: <br /> SB180 Posted Yes No Permit Posted Yes No Re-inspection on or After: , •, <br /> d C, 1i i oi 5z vcos <br /> /1 o c e K -� a <br /> 74#4 ni M 0 ell 0 <br /> 11 fe <br /> 2 Pr a S 444 ars <br /> ) .l 0 ' Cc <br /> U •;1u r : n r • a 4 o <br /> o' re r: lor 4 <br /> IQP 1,t1; 11 n o le. <br /> j9I R ' 2 <br /> WOO <br /> 6 <br /> 3- Com 12 S; "� k /0'n V5 04 <br /> F z Wie C r <br /> ✓, G 5 <br /> r. M On as// is G h O� A G / <br /> C POn q Gd OC/. I i .1 WC I <br /> d .0 I r �{n r <br /> 4 o e/6 <br /> Item/Location Temperature Item/Location Temperature <br /> - -- - . ....... ---- - --.. <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/Titl <br /> EH Specialist: Phone: LIJTLA <br /> f I/W <br /> Time in: / Time Out: - Z Page/of <br /> EHD 16-24 (2nd pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />