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SAN JOAQUIN COUI'.._ e <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> '• 600 East Main Street, Stockton, CA 95202-3029 <br /> Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:wwwaiaay.org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: 1 <br /> Address: City: Zip Code: <br /> Owner/Operator: Tel e. ,, 13 <br /> Program Element: Program Record: k—No <br /> 11 Inspecti n ype. a <br /> 8180 Posted ❑Yes El No Permit Posted ❑Yes 'T Re-lnspection on or After: <br /> 66SER11AT10NS ASVD C®F3F�ECTIUE <br /> AC <br /> T!©NS <br /> 3 Q&�. =�� <br /> i <br /> lk-AW2Ai� POL <br /> J <br /> Pe <br /> ftemlLocation3 Tem rater _- 7temlLocapon. Trtiperaturs ftem.l.locationmperatairE, <br /> �. - <br /> Food Safety Cer#ification;. Facility dot Waterxt mperatute „u Wirewaslhing _ <br /> Name: Hand Sink: of Chlorine. PPM Heat: <br /> Exp.Date: Warewashing Sink: of Quat.Amm.: PPM Other: `F <br /> Received By/Title: <br /> EH Specialist: Phone ry f!71 <br /> Time in: Time O t: v ! a Page f <br /> EHD 16-24 (2-Pg) 11009 FOOD PROGRAM OiR CONTINUATION <br />