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SAN JOAQUIN COU, <br /> '°p......., c <br /> •.oG <br /> a ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web:www.slgov.org/ehd <br /> L�F+ORt� <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: 1�na boy 6 r a r-) Date: 3 -36--15 <br /> Address: (0.j (+0 Pa C.. !`fC, � City: e 1_ C��n Zip Code: j 5-2_0-7 <br /> Owner/Operator: 5/A T7 c Tib Telephone: L0 7_Y2 17 <br /> Program Element: IIOZ$ Program Record: P RO ro2-12-9 9 Inspection Type: <br /> 8180 Posted ❑Yes ❑ Permit Posted ❑Yes ❑1 Re-Inspection on or After: <br /> U-e fc k V1 CLUS 01 vid CA--i 4n <br /> W a v- 'K 6o rn.Z u <br /> w 2_Ci <br /> A:+ Co D 1L •-e_ W 0Cie- <br /> L pe- ��"rl � 1'1 Ci• Y O t-(.'�-i 1-c..�_ �'J GZ�i <br /> ItemlLacation Temperature Item 1 Location Temperature <br /> Food Safety Certification Facility Clot Water Temperature Warewashing <br /> Name: Hand Sink: of Chlorine: PPM Heat: of <br /> Exp.Date: Warewashing Sink: of Quat.Amm.: ppm (Other: of <br /> Received By/Title: � lr i`,p ,t tgi— <br /> EH Specialist: f Phone: <br /> 6)5-3 _ "--? <br /> -' 2G <br /> I <br /> Time in: ( 2G Time Out: 1 ,'30 <br /> ' 2JD G Paget of / <br /> EHD 16-24 (211 pg) 4;3/13 FOOD PROGRAM 01R CONTINU,%-TION <br />