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SAN JOAQUIN COU�+f <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> c�•,. :�. Telephone: (209) 468-3420 Fax:(209) 464-0138 Web:www.slgov.or /g ehd <br /> 4ciioRa O-P1 aw ft <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Date: <br /> [a7meofFacility: n �`Y L Jam_ 1 City: ( 1/ � Zip Code: <br /> perator: r � s� [� Telephone: <br /> rogram Element: Program Record: f. 0Inspection Type: <br /> SB1RO Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> ty8 aEF31tAT1flTiS AI d;Ct)RRECTWe AAMIONS <br /> v 4 , - <br /> t- <br /> fuo>�e ' rrvrtit>!` 1� tl,�?ht� 7 .F <br /> Ary7l Gl eke- J M,1W-e / ot �/1 Yt � fG1hl�jZlc' 06c"tr <br /> (a v71L <br /> IterWLocaiion Temperature item t t.ocatign Temperature <br /> mat rj l0 <br /> jn_0v-q1 Wyxi,t-\ L te- <br /> t' i <br /> Food Safety Certification Facility Hint lNater Temperature ,. Warewashing <br /> Name: Hand Sink: of Chlorine: ppm Heat: of <br /> Exp.Date: Warewashing Sink: of Quat.Amm.: ppm Other: of <br /> Received By/Title: <br /> EH Specialist: !� Phone: <br /> Time in: Time Out: (Y/ ✓�S_0� Page f Z <br /> EHD 16-24 {2�pg} 4/3(13 f FOOD PROGRAM OR CONTINUATION <br />