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,opal�oG SAN JOAQUIN COUP ' <br /> .Z� ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.sigov.or 1q ehd <br /> �lFOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: R 7 oL(/ 777 Date: /2-/2-37/ 7 <br /> Address: S7�!/ City: �; Zip Code: <br /> Owner/Operator: Telephone: _swi9 <br /> Program Element: Program Record: �C% r�a Inspection Type:lim _ <br /> SB180 Posted Yes No Permit Poste Yes No Re-Inspection on or After: <br /> OBSERVATIONS AN©CORRECTIVE ACTK S, <br /> _(._ ._..........._... fl <br /> .......... <br /> 1Q4 .... <br /> .L. -----...._ <br /> _.......__._ ................ '_.W _ <br /> a, LSDP a <br /> u 9" em 'nature* �i�Locat�oiliperature <br /> V`tel <br /> Food'Safety�+L', rtsfl on :< �_�� acllity°}fofWater Temperaturshing <br /> Name: Hand Sink: 4F Chlorine: ppm Heat: of <br /> Exp.Date: Warewashing Sink: of Quat.Amm.: ppm Other: of <br /> Received By/Title: n3�W 4(, — <br /> EH Specialist: Phone: <br /> Time in: _Time Out: Pag of <br /> EHD 16-24 (2nd pg) 4!3+13 FOOD PROGRAM DIR CO&TINUATION <br />