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9.! t, SAN JOAQUIN COUNTYI <br /> p <br /> W , <br /> x ENVIRONMENTAL HEALTH DEPARTMENT <br /> :< <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web:www.sjgov.orglehd <br /> �lFORN <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: / <br /> Address: -z c City: 1 y r Zip Code: .� <br /> J : loci5 14 <br /> Owner/Operator: f _ Telephone: <br /> Program Element: Program Record: � ��� , �� a Inspectiori Type: C � <br /> I(000 <br /> 8180 Posted ❑Yes ❑ No Permit Posted Q Yes E7 No Re-Inspection on or After: <br /> -?�., � �� �ir. $ ���A;.-...�'.. ,...". �� �� �S� �^►I�l��l.$�,g '�a's�f+..�x'S�, sY��x ��`wk,r1v ��yh�, r�;�?" ia.v+-,-. <br /> bitiw''4dt? iauR �a4;, � '�.. s �•5ii'sr�...,n: h.�"' ..a.. xrt�c'-L��rL,�,'r,�3ea7S-'"..'4�, �s.,ic. t t- e Y � d,^:� 'l^. 'Yr V <br /> y� /7 I� y-, A� <br /> j 12 <br /> rK �fe <br /> bservq,4- u� <br /> 1 Y1 -2 Li 14 a_6b VSA-�- ti,-- —- 6ull-0- d9-'► CCA Lc rt <br /> �ltii r Z r <br /> R,,4 <br /> i <br /> Name: Hand Sink: OF Chlorine: ppm Heat: OF <br /> Exp.Date: Warewashing Sink: of Quat.Amm.: ppm Other: OF <br /> Received By/Title: <br /> EH Specialist: Phone: g� <br /> Time in: -' 55 Time Out: f J /D <br /> Page I of <br /> EHD 16-23(2^d pg) 0712`9109 ! I FOOD PROGRAM OIR CONTINUATION <br />