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r <br /> SAN JOAQUIN COUNTY <br /> �+ ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax: (209)464-0138 Web:www.so <br /> 4tFpit <br />'1 <br /> 1 <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: U U t ¢ Date: <br /> Address: 3 z G c) � �p City: ��� Zip Code: <br /> Owner/Operator: p e 4 Ad j` Or <br /> ?t(' 61 Telephone: <br /> Program Element: <br /> 1602 <br /> Program Record: GU s�6 Inspection Type: ; <br /> ns 1aG �� <br /> B180 Posted ❑Yes ❑ Rermit Posted ❑Yes ❑1 Re-Inspection on or After: <br /> r N!mowM. q........ . _...v <br /> fU J; ' Lk)rn a J e ofJj <br /> 6_0 If cc 1 As <br /> 12) • r u 1 1';ar f rJ LjJV <br /> G .i 'A .� uJ Its q ,� <br /> V. <br /> I ruv ; d rro YY1.a 4 <br /> roo ;de So oa iGw !3 Q t l <br /> �v U <br /> Cie S P C I C',5 <br /> eros4c'4r G,r. 24n C c,iv <br /> or 12 e IGuJ <br /> 0. t i 1 0 h re n a ✓e brPn o1 <br /> L <br /> )(A AK ,mC <br /> -3 <br /> _.. .... m <br /> CA -�v1 j l ��a r SCI -LrcC.,) <br /> 3 7F <br /> y <br /> a. <br /> Name: Hand Sink: /1 of Chlorine: ppm Heat: of <br /> Exp.Date: arewashing Sink: �Vjt of Quat.Amm.: ppm ther: of <br /> Received By!Title: y <br /> EH Specialist: Phone: 4 G 1 Y <br /> ime in: UU Time Out: O C/ Page of <br /> EHD 11-24 (2'd pg) 413113 FOOD PROGRAM OIR CONTINUATION <br /> V <br />