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oP4"I" SAN JOAQUIN COUNO <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209)468-3420 Fax:(209) 464-0138 Web:www.s'gov.org/ehd <br /> �IFOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: ` ; 1! �' Date: - <br /> Address: Cit Zi Code: p <br /> y• —Fro P /S 7,C <br /> Owner/Operator: Telephone: <br /> Program Element: Program Record: Inspection Type: p <br /> !SB180 Posted vies No Permit Posted Oes No Re-Inspection on or After: <br /> 'OBSERVATIGINS ANQ AFI. EC 1 E A TI NS <br /> Foo d Un 6 Gaye in rP I; �cr Gi n6/ sCi AC-t <br /> yn b a Ln t ire <br /> r. C�O` i c l �o ��u <br /> Ke T Or\ G� OL'Y f( i; j rf- 46r !.-We IN P ale, r <br /> odp <br /> 3 C h Cc,," a. -2-Cc*V <br /> r 3 - Cc,� � . WG 1'00 ,> n <br /> (A It, <br /> e <br /> N ISc„ r Cl 4 olfc,,r of 0,oa t -Pr re Ger. Ifl ra <br /> No IC . i Gt/ <br /> 0 k ✓ . / 4c <br /> SCe/t17 T'11"MP <br /> Item/Location Temperature Item/Location Temperature <br /> y ---------._..._.___ -- <br /> r bG-c ti n I-doc,. 3 5 , <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Hand Sink: 'F Chlorine: ppm Heat: °F <br /> Exp.Date: Warewashing Sink: 'F Quat.Amm.: ppm Other: 'F <br /> G <br /> Received By/Title: <br /> EH Specialist: - Phone: <br /> Time in: /`,,U Y Time Out: �, Page�of� <br /> EHD 16-24 (2n'pg) 4/3/13 V FOOD PROGRAM OR CONTINUATION <br />