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SAN JOAQUIN COUN_ <br /> � •.OG <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.sigov.org/ehd <br /> ��FORl� <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: To <br /> Date: 3•, 2*. / y <br /> Address: ' .L / ��) I n t City: %r `1 ( u Zip Code: <br /> Owner/Operator: Telephone: 7 <br /> Program Element: Program Record: Inspection Type: II <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> I 17tni •t/ p/1 he or Gn 6110n G-Pilin irk <br /> S mG Il Wo. W -i C leo ri 'jc <br /> 2 '' 10/• u S r a- S ct 11 LJ u J - i r� a n at <br /> n So dq n 0 z Z les. c l o c/u <br /> 3 II 1; 1 e,5 6 Vc srn q it w ae <br /> C'(I. "I t 4o c�4 <br /> 6ro.4 IC'C lot) q 4o i �• /P lOn lar <br /> U�aJ n, r l � c� <br /> t I <br /> Item/Location Temperature item Location Temp rature <br /> doorb <br /> t C rP 1 r YR OGj� bee 1M;(rcwcolc4 �Y Fr <br /> b 1 <br /> Ro ,JIS F #'S 4'. 4C• l �/- <br /> LA <br /> -- <br /> Food Safety,Certification Facility Hot Water Temperature Warewashing <br /> Name: ti ; Hand Sink: Gc `F Chlorine: ppm Heat:, F <br /> Exp.Date: / arewashing Sink: �?G Coat.Amm.: Other:� �F ppm 'F <br /> Received By/Title: <br /> EH Specialist: Phone: 601, <br /> Time in: Time Out: Page of <br /> I U'. N.S /I. 3 2— z <br /> EHD 16-24 (2^a pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />