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SAN JOAQUIN COUNTY <br /> app' <br /> a 2< ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> Telephone: (209) 468-3420 Fax: (209) 464-0138 Web:www.sigov.org/ehd i <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: { c,1 Date: <br /> Address: \p,s o �7 �y� City: --C-r� Zip Code: <br /> Owner/Operator: � Telephone: <br /> i <br /> Program Element: k`40 1 Program Record: 33 lnspection Type: <br /> 5B480 Posted ❑Yes ❑ No Permit Posted ElYes [] No Re-Inspection on or After: <br /> I <br /> QBSERNA�T[O�I$ N;p CO<�ECTIVACTII'$ �N <br /> C Q 3 Z.a <br /> S . 4� - � . � s \ S <br /> S\ c ,. RC1•, e1r-�•c� 2 -F:�r <br /> C - k\ 2 J Q <br /> btu.; r CA t <br /> i <br /> - sZ A-C7 <br /> I <br /> t ca T. T p ure <br /> 00Cal. : F F c'i to a., erieratu..e s 'rn <br /> Name: and Sink: of .Chlorine: ppm Heat: of <br /> Exp.Date: arewashing Sink: 9F Quat.Amm.; ppm then: of <br /> Received By 1 Title: <br /> EH Specialist: 4 Phone: u <br /> Time in. O Time Out: 1 Page of <br /> EHO16-24 I21'p9} 1112109 FOOD Olft CONTINUATION <br />