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SAN JOAQUIN COUNT'S <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.slgov.orglehd <br /> 41�pR <br /> FOOD PROGRAM! OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: <br /> Address: �D /f k I !f- City: Zip Code: <br /> Owner/Operator: Telephone: <br /> Program Element: Program Record: S� Inspection Type: <br /> S8180 Posted Yes 0 No Permit Posted Xyes [I No Re-inspection on or After: <br /> 0113SSAVATIQALO <br /> ECTfVE ACTIONS <br /> WL 30 <br /> lulu �.L �- wi rs � yt� <br /> Item/Location; Temperature Item I Lavation: Temperature, item i Location Temperature <br /> tAe4 k)K �,M a !e.P7 A4-ems. <br /> Y 19'1 rV_& Fi�zen 1 101f <br /> Food Safe CerYificatiart facility Hbt Water fiemperature Whrewashtng <br /> Name: p_ Hand Sink: 11611f aF Chlorine: ppm Heat: of <br /> Exp.Date: rT arewashingSink: aF Quat.Amm.: ppm Other: of <br /> Received By Title: ' <br /> EH Specialist: t� Phone: <br /> Time in: . d Time Out: Page of <br /> . 6r <br /> EHL)16-24 (2,dpg) 1112109 FOOL)PROGRAM OIR CONTINUATION <br />