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°�"�" SAN .JOAQUIN COU' <br /> 'o ...........o / <br /> � •.off <br /> wj�io ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax: (209)464-0138 Weh:www.sjgov.org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: <br /> Address: City: Zip Code:I _� rl 1215')-0-77 <br /> Owner/Operator: <br /> Telephone: L4_76 -9a92 <br /> Program Element: Program Record: (2 q Inspection Type: y, <br /> B180 Posted �'es ❑ Rermit Posted )4 Yes ❑ 1 1 Re-Inspection on or After: � �'`-C• <br /> ®QA- coo r_ - Hort µc.Lo-ot r) I <br /> D o d b a)n n o i s I2� n <br /> -%!5 <br /> 71,160 6tr W.L <br /> h q VLA ` _U t <br /> Ya ha r,-ea n cA k, + Ve.r 3 V7 C4 V-e- <br /> h l v r in_t tJ- 5 +Y-(' 193P o .t au r�-i (a F,(-.t <br /> r 0Lt-t' d� <br /> r tb C i_e F <br /> cJ cp --F_pz -�-CG, c 0 A-k r 2 rLt ro v-� <br /> 4i h tU. ci <br /> <""mss, <br /> Name: Hand Sink: ofChlorine: ppm Heat: of <br /> Exp.Date: Warewashing Sink: OF Quat.Amm.: ppm Other: of <br /> Received By 1 Title: <br /> EH Specialist: - W1 ( t� 1_ _ •1M� Phone: 3_ r� I ✓� <br /> Time in: t j �1 �' lL ►'�/✓� Time Out: �r Pagee <br /> R. <br /> EHD 16-24 (2"'pg) 413113 FOOD PROGRAM OIR CONTINUATION <br />