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SAN JOAQUIN COUI, f <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> -_ 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> �q..I, a�P Telephone: (209) 468-3420 Fax: (209)464-0138 Web:www.sigov.org/ehd <br /> � FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: r; , y � Date: <br /> A <br /> Address: rc City: �""' Zip Code: <br /> Owner/Operator: Telephone: <br /> Program Element: Program Record: Inspection Type: Cs <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> C0 r 01 h O r cr I hoor, Oe eni c vIo dr, <br /> l oeld Cr\ h , ' 1- <br /> o lC ✓pa vc pro J ry AC An <br /> A u: -N O C <br /> 3- cc rn p > <br /> A 9 c lei�h rcu � . 1,cy 9r,� a 1;4; <br /> u cKe f an d Gr / ' �� cr <br /> 4adu <br /> rs . t h 11 PrS 4cic 4 <br /> Item/Location Temperature Item/Location Temperature <br /> Ii)G+r 11A - o&r r 37 /' <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: �G ` r 'F Chlorine: ppm Heat: OF <br /> Warewashin Sink: Quat.Amm.: PP Other: o <br /> Exp.Date: y a Y / G/ g 1 °F m F <br /> Received By/Title: <br /> EH Specialist: �( Phone: -316 <br /> oe0 <br /> Time in: �n. Time Out: T Page of <br /> aC J <br /> EHD 16-24 (2n1 pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />