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r <br /> SAN JOAQUIN COUN,.W <br /> q` ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax: (209)464-0138 Web:)8 .s' ov.or lehd <br /> �iFOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: -1 S_ <br /> Address: k-1 <br /> 1—f �� �Q \ Q� p City. Zip Code: <br /> Owner/Operator: �G + y MO(f 15(2 • • Telephone: <br /> Program Element: �b2 Program Record: b2 :A AS Inspection Type:Is <br /> B180 Posted XYes ❑ Rermit Posted Yes ❑ 1 Re-Inspection on or Atter: \ <br /> I - <br /> _3� s-TLMP Trak 2.Moret , <br /> iso• <br /> Square th.r" ■ 7rC y <br /> bh eFri.s r' <br /> C 1 ` 170•F W <br /> �) fro�R1-ra 7TC µ <br /> �.rae,i d1 <br /> 2 —f 2. `�l C� 2 11�! 0 &2*CF o <br /> 1 { - 11 <br /> r � Tlem <br /> der1ri IFA$ <br /> Name: Hand Sink: 1 `F Chlorine: ppm Heat: ` KD of <br /> Exp.Date: �— 2�1 a !hing Sink: l 1 of Quat.Amm.: ppm they: aF <br /> Received By!Title: L\ jFn h <br /> EH Specialist: _ Phone: _1 b�3-0 70 <br /> ime in: -ZN Time Out: 3 25 PageZof <br /> EHD 1624 {2'd pg} 413193 FOOD PROGRAM OF CONTINUATION <br />