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SAN JOAQUIN COTY <br /> �o.�•coc <br /> e: a <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> may..., a;P Telephone:(209) 468-3420 Fax:(209)464-0138 Web:www.sigov.org/ehd <br /> �/FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: , ` ` Date: a/ /1 /` <br /> Address: ^'7 ,44 G,// City: Zip Code: <br /> Owner/Operator: (� Telephone: <br /> Program Element: t` Program Record: /, 4 - �. Inspection Type: G � <br /> IS B180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> 'OB <br /> Wtea: <br /> u p� <br /> n- <br /> MT <br /> t <br /> ( .���V1�he%LIyL_ <br /> _ <br /> ,tJY� <br /> N <br /> ........................ <br /> ff ' ALK4W, - 1 6 <br /> G <br /> lar) k h 103 ' <br /> � <br /> kin tIUA . <br /> �-�►� w i vt4l MtpL — D. <br /> Yry <br /> ... ft I1t�bCtit� X f�� x= OC8t1:rt <br /> 91 <br /> G <br /> Food Safety Certification Facilrty Hot:Water Temperature waTi6 washing <br /> r y t � -- <br /> Name: - Hand Sink: F Chlorine: ppm °F <br /> Exp.Date: + .• I arewashing Sink: -F Quat.Amm.: `J<1. Ppm Other: -F <br /> I t <br /> Received By/Title: r-_ - <br /> EH Specialist: ' Phone: C- <br /> Time in: /� Time Out: Page of <br /> FHD 16-24 (2n°pg) 4/3/13 FOOD PROGRAM OIR CONTINJATION <br />