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1 A` <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web:www.s og v.or_glehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: , c Date: ' <br /> Address: O City: Zip Code: <br /> Owner/Operator: N e. r4eta Womffn A - Telephone: �G 3 � 9? <br /> Program Element: rogram Record: ? Inspection Type: <br /> B180 Posted Yes o No Permit Posted Yes 0 No Re-Inspection on or After: <br /> ANA <br /> .v _� ft, `"a .�. <br /> y r. ny. i' _t,,, .,i€a n, ni« _� <br /> ". r. A, kee <br /> m¢ a n c _ ross <br /> 06&QMA 17fon Fo o rile <br /> d k <br /> d r-n �(?rc6r , AD <br /> ChM-4 FOvd <br /> pN a d <br /> Area. o? or i�si, P q(",F y` <br /> k 17` .5061,0 f PA <br /> e-e- 1 S .6 @ 1 67e* <br /> 549.. 1L. vu/rottfs 0o g ` v <br /> 1 Vir <br /> s b� <br /> 00 r <br /> oor - !�- e; Trus ado- F 'r <br /> r dor✓- �r;d e k�" I <br /> Name: Hand Sink: , OTc of Chlorine: 0 ppm Heat: OF <br /> Exp.Date: QS _ 3 _ O arewashing Sink: D OF Quat.Amm.: ppm Other: OF <br /> Received By/Title: <br /> EH Specialist: Phone: <br /> Time in:1/� �14 Time Out: /« Page of <br /> 01 <br /> EHD 16-23 (2n1 Pg) 07129109 FOOD PROGRAM OIR CONTINUATION <br />