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SAN JOAOUIN COUI. . f <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 /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: - h., I `4". i `,r` Date: 7? :, y <br /> Ir Address: I City: c j i Zip Code: 9f3jC <br /> Owner/Operator: 1 Telephone: A '.2 (71 C C/ <br /> Program Element: Program Record: Inspection Type: La <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> f � <br /> AC0SERVATI©N5AND CO CT1VETONS <br /> u• - <br /> 2 J. <br /> s h 1 '► g r <br /> moos C le a nq hieS r -r• C+1 h . <br /> ? <br /> Provicle. 01 way A her, 4 <br /> P $ •F 1- S Prov <br /> -- - <br /> Item/Location Temperature Item J Location Temperature <br /> --- _.e <br /> 2 G - T 2-dGtr) y r r <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> ---- - —. _...---- _ ...._...-------------------------------- <br /> Name: Hand Sink: of Chlorine: M Hea • of <br /> k h SS JE�C 2 , PP � I�jC <br /> Exp.Date: / I arewashing Sink: /Z Z of Quat.A m.: PPM Other: of <br /> Received By/Title: ti <br /> EH Specialist: Phone: <br /> 41 r.J <br /> Time in: Time Out: Page of <br /> EHD 16-24 (2n°pg) 4/3/13 FOOD PROGRAM DIP CONTINUATION <br />