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Pqu�" SAN JOAQUIN COUP <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax:(209) 464-0138 Web:www.slgov.org/ehd <br /> L/FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: �,, �J � Date: <br /> Address: W '/ liL / City: Zip Code: <br /> Owner/Operator: 'J Telephone: <br /> Program Element: Program Record: G Inspection Type: 1-�Il y <br /> 7 ' <br /> SB180 Posted es No Permit Posted Yes No Re-Inspection on or After: Z <br /> m <br /> r;f <br /> i (I L60*4 <br /> 1U� 1� �" t�UI � �7y� � �GGw t�V7�✓1�.,.1+i ��++ `, '.1 �, �.0 r ;�,'.� . <br /> t pcation Temper ture <br /> Item//Location Temperature <br /> - <br /> L / v <br /> Of- <br /> Food Safety Certification Facility Hot Water Temperature Warewashmg <br /> Name: !/ alL f_ � �� l�(�`� Hand Sink: / of Chlorine. ppm Heat: of <br /> Exp.Dat/e`:— Warewashing Sink: of Quat.Amm.: ppm Other: of <br /> Received By/Title: <br /> EH Specialist: 0( <br /> M 1 Phone: <br /> Time in: 1 " (5 <br /> ( Time Out: i Page of <br /> EHD 16-24 (2n°pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />