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oPA"`"' r • SAN JOAQUIN COUIPY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> • Coq., _m �P• Telephone: (209)468-3420 Fax: (209)464-0138 Web:www.siaov.ora/ehd <br /> �l Fi1'R� <br /> FOOD PROGRAM QFFICIAL INSPECTION REPORT <br /> Name of Facility: " 1,1J ,-./ Date: 2 <br /> ddress: a^ Clty: Zip Code: <br /> wner/Operato : L Telephone: <br /> Program Element: Program Record: ¢( S/ Inspecti STy l r t. 1 <br /> 8180 Posted ❑Yes ❑ No Permit Posted ❑Yes [] No / Re-Inspection on Or After: G <br /> S A-1 ;-J al az <br /> - t <br /> vl <br /> tf IR(e(PLe, a <br /> bvAv 15holif bir ja ftni1?� <br /> ki&-aa Aw c <br /> f /t r / <br /> rt l ✓ <br /> fe <br /> wwo <br /> s <br /> 1 k'p l to tav(xn <br /> s 3 <br /> SAllr Uvw <br /> 1 1.6-1✓ 1 OVX <br /> o Dv Y. <br /> 1 d VnVE Id hWAt4y,/� <br /> n ✓ r «f%tc / GSC vt < t <br /> ttKin V V AV <br /> Item/Location - Temperature Item I Location ' 'Temperature'.'. Item!Location _l_Temperature'. <br /> Food Safety Certification ': Facility Hot Water Temperature Warewashing <br /> Name: - Hand Sink: of Chlorine: PPm Heat: of <br /> Exp. Date: arewashing Sink: of Quat.Amm.: PPM Other: of <br /> Received By/Title: <br /> EH Specialist: Phone: _ <br /> Time in: .I` Time Out: & ` Pag of <br /> EHD 16-23 (2^ pg) 11/06108 FOOD OIR CONTINUATION <br />