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SAN JOAQUIN COUP <br /> ITF <br /> Z� ENVIRONMENTAL HEALTH DEPARTMENT <br /> = 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> �'•.. ;p Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.slQov.orq/ehd <br /> 9C]P0'�c� <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: &.7)_ j y <br /> Address: ' 6 ��Z ll 1 City: L ciJ h rct, Zip Code: '95 330 <br /> rArl� ., <br /> Owner/Operator: Telephone: <br /> Program Element: Program Record: Inspection Type: <br /> CU ^C <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> x <br /> r <br /> c)t, �l /� 8 Le ve.-� cc C/ <br /> Item/Location Temperature Item/Location Temperature <br /> - r-L. a Xe l i'N. <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: 1 Hand Sink: �Li t, of Chlorine: ppm Heat: of <br /> Exp.Date: rt Warewashing Sink: of Quat.Amm.: ppm Other: of <br /> Received By/Title: ' C-t t I <br /> EH Specialist: Phone: //6 k_ /6Y <br /> Time in: (- . { Time Out: Q ` Page of <br /> EHD 16-24 (2''pg) 4/3/13 '7 FOOD PROGRAM OR CONTINUATION <br />