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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> N: x <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> Telephone:(209) 468-3420 Fax.(209) 464-0138 Web:www.slaay.org/ehd <br /> 4Lf�a�� <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of f=acility: � c1 Date: <br /> Address: �I City: Zip Code: <br /> Owner/Operator: _ R C Telephone: f <br /> Program Element: gram Record: C M 333 Inspection Type: /a, <br /> SS180 Posted ❑Yes [I No Permit Posted ,❑Yes ❑ No � V v Re-Inspection on or After: <br /> t3 <br /> i)BSEI3�IATI© S � <br /> " DFF3EGTNE��GTiONS` . <br /> �.. ° <br /> 3ts.�i�.� �' � ,...S.n s--s^x s°�. � R� •�.- FF:Y:t!@ <br /> vvieG( r�` C C `t Cil X <br /> r � C4' (a( <br /> to ►._ �. . T��rtperature, temcat b rata i "® 1#e n . : Y "m; em rafiurei; <br /> Name: Hand Sink: of Chlorine: ppm Heat: oP <br /> Exp.Date: Warewashing Sink: of Quat.Amm.: ppm Other: oP <br /> Received By I Title:y-ly-My OE <br /> EH Specialist: r <br /> Phone: <br /> Time in: Time Out: Page of <br /> LKI <br /> EFiD 16-24(2-pg) 1112109 FOOD PROGRAM OIR CONTINUATION <br /> i <br />