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oPa�l" SAN JOAQUIN COL Y <br /> a X ENVIRONMENTAL HEALTH DEPARTMENT <br /> - = 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> �4•..• ,..�;:P Telephone:(209) 468-3420 Fax:(209)464-0138 Web:www.sigov.orq/ehd <br /> <<FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT KCH7 <br /> Name of Facility: h 1r`G Date: /_ <br /> Address: 15 35 0 Q c-t <br /> --r— City: ,to C4L.o h Zip Code: q5.24 7 <br /> Owner/Operator: 51par Telephone: L1'7(P- I q0'? <br /> Program Element: I.('07 Program Record: P P-05 a ( Inspection Type: <br /> SB180 Posted *Yes No Permit Postedq�,Yes No Re-Inspection on or After: <br /> ... AT <br /> '_ <br /> C <br /> ... 3. C?BSERVIt3NS`A1PiD3RRECTIVEA <br /> x � . <br /> - —--- <br /> _o <br /> . 'a d-oo r -- d c,� n a CC i, de,n oui h --- -`fM CAA, <br /> •n �'i..n._....... a+ ---- -�l_Ip___.1D y <br /> _- ......_n..C<... tt n 4 r---......-- ..............-...... <br /> ✓Cl 'f'D -e-a-c- o r n V <br /> or rre- <br /> t, ltern oca#i�?tt � em nature �. „ item Location <br /> A d4-a v.* 2dco�� Lte bo <br /> rn.cir, 4 s <br /> - Y y5 F :eri 4Imo+ c -z. c44 150`# <br /> (!I rWer» b eu r�5 Vj C <br /> -- <br /> �F_o�ii� a r Gart�f� incilriy Ho W to a ratu�e r... W,retnrashIng i <br /> Name: K le tri Hand Sink: 4c) o f Chlorine: ppm Heat: 'F <br /> Exp.Date: '�y_ '30�) ? arewashing Sink: ; 2 G1 'F Quat.Amm.:D_�D ppm Other: aF <br /> Received By/Title: <br /> EH Specialist: Phone: <br /> Time in: O1 0 Time Out: Pag%!f 2 <br /> EHD 16-24 (2n°pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />