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uii?.q-_ SAN JOAQUIN COUNTY <br /> ENVIR. UMENTAL HEALTH DER TMENT <br /> 600 E. Main Street, Stockton,CA 95202-3029 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Y R( i Date: p <br /> Address. �Zo `I,1/a�gJ y N �,}r ' ` QUA W'4 c�J City cr`]'�,<�� Zip Code: 5"% <br /> Owner/Operator- one: <br /> Teleph �3u�� <br /> �E-Rvr4,v7� R �S 7 <br /> Program Element Code: Program Record ID: Inspection Type: <br /> SBt80 Posted D Yes 0 No Permit Posted D Yes D No Reinspection On or After: <br /> 6-w1 U+577} 5 &.2E 1 Aja ,t eoe<-0 I�LI)67 k� <br /> J �W flJC]S !�N �vly r .�i A-C' S aT`TL�F� 1�K2F <br /> *rti rvA W r 3'v iova <br /> Cr <br /> 5'� S �i� THE cQ luau r t.L. JA!-ri( ou�s Cyf,�i <br /> !*e4x3(AkD 1- 131 /970)"L1'T/S oiv,t Ni9L�6roS N� C'ate�ANP*' <br /> T TWE et(CC— !-O e L7—r' <br /> IIMAa <br /> rE2 u e rS! 7'h <br /> Alt> tE2S 4N1. GcG� -� <br /> NL w -Irrvlr 15 CAR 5f AIX 6;-0/ Ss <br /> lA-1- / N 5 !. 14 g t t <br /> (� t�U E u ►� C t� 5'0 /�i9/vb 26-1 <br /> . .4,r%Ad A. A <br /> BOX 5 ry nj <br /> o 6 `)B <br /> � A <br /> ,I <br /> Name: Hand Sink: °F Chlorine: <br /> ppm Heat: °F <br /> Exp.Date: arewashing Sink: -F Quat-Amm. ppm Other: ppm <br /> ENV MENTAL HEALTH ICE CHWE FEES ARE AUTHORIZED BY RESOLUTION OF THE SAN JOAQUIN COUNTY BOARD OF SUPERVISORS. <br /> L OCUME TED GR OLATIONS OR REPEAT VIOLATIONS ARE SUBJECT TO A REINSPECTION AND REINSPECTION FEE. <br /> Received By: Title: <br /> EH Specialist: Phone: (L/� <br /> Time In: �•-�(7 Time Out: Page: of <br /> EHD 16-23(2N0 PG} FOOD PROGRAM OIR <br />