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O.P�C <br /> 4wlg SAN JOAOUIN COU Y <br /> � . D <br /> N: X <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> c4.. ip Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.si4ov.orq/ehd <br /> ��FORN <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Com, '�JYL Date: 3 /1 <br /> l <br /> Address: ti l9/. U IrLti (ice City: ('� fit Zip Code: <br /> V <br /> Owner/Operator: �n r �I Z���� Telephone: <br /> Program Element: �t /Program Record: g G-L-7 / _ S-7 <br /> 1 Inspection Type: � <br /> SB180 Poste Yes P No Permit Posted Yes [_ No / Re-Inspection on or After: <br /> q) I <br /> -i: � � # + FAQ" `�'•?= <br /> d VV Z.. �'�/�f%'(,1/t'c•'�,'L,'ZL� �1,L-�' I. � ��. <br /> L <br /> ago 01 <br /> U4,V14-1Name: Hand Sink: of Chlorine: ppm Heat: of <br /> Exp.Date: Warewashing Sink: of Quat.Amm.: Ppm Other: of <br /> Received By/Title: ; <br /> EH Specialist: Vvl/L Phone: <br /> Time in: f ), Time Out: Q Page�f <br /> EHD 16-24 (2nd pg) 4/9/12/ FOOD PROGRAM OIR CONTINUATION <br />