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SAN JOAQUIN COU Y <br /> 'pp.. ...., cO <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax: (209)464-0138 Web:www.sigov.org/ehd <br /> �lFORN <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: _ A✓ Date: <br /> ddress: Lr.7 2 L City: 64.0 n Zip Code: 9 5 20-7 <br /> Owner/Operator: <br /> �5 �_r?S� <br /> �/-C /7't ASI "F Telephone: <br /> Program Element: / I Program Record: ID n'` 4 0.2 Inspection <br /> $y Inspection TypeK8_0Posted <br /> : /2_j <br /> Yes El Permit Posted es ❑1 Re-Inspection on or After: / <br /> IUD n CL aCe r L"s O cu+- 0-4'- 6ey-V-ri ha til <br /> 2 s Cu,s 4o ru Y 5-c L . - Sc r-e- no t- <br /> ,.-Q `vi -I- s A 11 K-en <br /> )R;?cc <br /> Y r V-2 z <br /> CA\i2 4-h s . <br /> Item/Location "� � <br /> -��e�sz���'��;a ': (t{:rn 1�,.QC��(! � Temperature <br /> k�c _? . <br /> 7 <br /> r <br /> Food Safety Gecbfiraataon Facility Hofi Water<� roper War sa' <br /> ature <br /> Name: Hand Sink. of Chlorine: ppm Heat. 'F` <br /> Exp.Date: Warewashing Sink: aF uat.Amro.: ppm Other. eF <br /> Received By/Title' <br /> EH Specialist: IOU <br /> Phone: <br /> Time in: 0Time Out: '11 31_5 <br /> 6 Page of <br /> EHD 16-24 (2n1 pg) 4/3{/13 FOOD PROGRAM OR CONTINUATION <br />