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SAN .10AQUIN COU' -Y <br /> �+ ENVIRONMENTAL HEALTH DEPARTMENT <br /> N: X <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web:www.sogov.org/ehd <br /> 9�rFOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: /4 C, bq ' Date:tf, <br /> Address: 1 I/V City: Zip Code: <br /> Owner/Operator: Telephone: <br /> Program Elemen v Program Rekord: !" Ky v Inspection Typ Y� <br /> 10 W <br /> 6180 Posted ❑Yes ❑ Rermit Posted ❑Yes ❑I Re-Inspection on or After: <br /> AgA 41'4 <br /> G� - <br /> Q� <br /> lr�l�► S- �urY� ti <br /> �1 ��� �,, �� � � __ � � ___anon z � Temperature <br /> ItemtLoca '" `'�` a nature Itern/Loc _. <br /> �n Foadan.. ,— - <br /> Safety Certification �( Facility Hot Water Temperature q Warewasbing , <br /> >' <br /> :. <br /> Name: Hand Sink: of Chlorine _: ppm Heat: of <br /> Exp.Date: arewashing Sink: of Quat.Amm.: ppmOther: of <br /> Received By/Titl <br /> EH Specialist: Phone: <br /> Time in: f Time Out: II Page of <br /> EHD 16-24 (2n°pg) 4,13113 FOOD PROGRAM OR CONTINUATION <br />