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SAN JOAQUIN COUi ' <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> �4•... ��P Telephone:(209) 468-3420 Fax:(209)464-0138 Web:www.slgov.org/ehd <br /> �/FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: , ` Date: _I C <br /> Address: City: Zip Code: <br /> Owner/Operator: Cl Telephone: F3 lea y <br /> Program Element: ��5 Program Rec d: II SSG( Inspection Type: {�u <br /> SB180 Posted Yes No Permit Posted Yes No N Re-Inspection on or After: <br /> atM V;dlc'Ir e-0C f' eYCC At <br /> �f Foo.4 G \ (� Ike t(�IOc t �/1 b 4 Ile'%nJ 1C t o Cl elcc� 6 <br /> C {�O5 a -F �F IhC Doc r C� rrec • l= e"P <br /> s <br /> (A); A ' n C /a ah an D re io Iahle. Jfc W. Pi / - / <br /> in r 1 i Zer, c `- <br /> �cd'q <br /> vv�{ of nCcve.-cd ;n Wo c W-A <br /> r S, Is 34-ore d ;n hA WC a)01 . wl a ler. <br /> I C¢ yl l` or less) or ho Wnter /S S'f yr rV7 are <br /> 0 rr cl +G,c� A <br /> 3-co"" ;r s e ci 6 02S rl k Un us <br /> Cc G 0 14 free <br /> Item/Location Temperature Item/Location Temperature <br /> Food Safety Certifica ' Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: of Chlorine: Ppm Heat: of <br /> Exp.Date: IV Warewashing Sink: of Ouat.Amm.: ppm Other: of <br /> Received By/Title: GW N P l <br /> EH Specialist: Phone: <br /> Time in: 4 C Time Out: j . C, v Page 0� <br /> EHD 16-24 (20°pg) 4/3/13 J FOOD PROGRAM OIR CONTINUATION <br />