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SAN JOAQUIN COU�4Y <br /> m; ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> .. P Telephone:(209) 468-3420 Fax: (209)464-0138 Web:www.sigov.org/ehd <br /> ,41FOA� <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: ` `., Date: T177777 <br /> ddress: / 7�. ?h ` City: //L. Zip Code: <br /> wner/Operator; �L/lav L CX t..r Telephone: �A-r <br /> Program Element: D Program Record: D Inspection T <br /> B180 Posted Yes No Permit Posted Yes No Re-Inspection on orFAfter: <br /> VATIONS AND s <br /> 1(!Vit• �f� �G d -- -- <br /> it <br /> S I N ey dfe <br /> a d1m r OU wll <br /> 60100A H <br /> rkf oWA !J C We <br /> l✓1 R I 3le /neh, <br /> .� fJ ✓1 J Q /rl <br /> R <br /> (� r� Imo` <br /> Itn.Od.el NPr✓ a Pr W � <br /> a v Ph l� <br /> Cr r - l 3 -G v l 1 Ot7 Wk k <br /> Item/Location '7114mPerature , i: Location <br /> L <br /> P I I,,` {4j N hN waI4-� <br /> Hon 'Factlity`Hof Water Temperature Warewashing <br /> e; Hand Sink: of Chlorine: Ppm Heat: `F <br /> xp.Date: arewashing Sink: ;F- uat.Amm.: ppm Other: eF <br /> M <br /> eceived By/Tiff <br /> H Specialist: INVV Phone: <br /> ime in: Time Out: Page of <br /> EHD 1624 (2m pg) 4/3/13 l J FOOD PROGRAM OIR CONTINUATION <br />