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P4"I" SAN .JOAQUIN COUNTY �Qp� <br /> 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/e_hd <br /> �IFORt� I <br /> I <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: f.1c t S Date:k L—zq— <br /> ddress: —1 + ^1 � City: Zip Code: <br /> Owner/Operator: v`J Telephone: Q2 '1 a� <br /> Program Element: 1 ko�y Program Record: k �26 k Inspection Type: v J L <br /> 8180 Posted Li Yes Li No f Permit Posted ❑Yes ❑No Re-Inspection on or After: <br /> 1 M-0-1-19MINOWS 'MOM <br /> t <br /> 10 c <br /> C'ls <br /> e e 1e - <br /> e C CG. <br /> bo cAs <br /> AA-12 <br /> c -r: n <br /> 01 <br /> 11 1 10111 111 <br /> M1 A IBM= <br /> Name: Hand Sink: 1 of Chlorine: ppm Heat: of <br /> Exp.Date: , ` arewashing Sink: of Quat.Amm.: ppm Other: of <br /> Received By I Title: <br /> EH Specialist: Phone: ` f, <br /> time in: Time Out: '", Page�of <br /> r+,� <br /> EHD 1&24 (2^d pg) 11009 FOOD PROGRAM CIR CONTINUATION <br />