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"1' SAN JOAQUIN COON' <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 /> ��F O illi <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: 11,T5 A4c, Date: <br /> Address: Cl�� r (7 City: OG Zip Code: 6 <br /> Owner/Operator: �� Telephone: <br /> Program Element: J Program Record: Inspection Type: 12,C)1c ( _ <br /> SB180 Posted 'des No Permit Posted Yes No Re-Inspection on or After: <br /> t <br /> .'v c c-0, C rx�K <br /> d t��c ` r^ . T��h t. �S at r-ov. c�.�a n a <br /> Prov i <br /> Q <br /> � <br /> -y O- cwt C�Q �o dIcz <br /> 1 t's— i'+ <br /> Aep.tq'r 16j, <br /> Item/Location Temperature Item t Location Temperature <br /> Pt ry,i fJ 1 5 91 a �j^ - <br /> d <br /> w I CiN <br /> I 1200c 0 Q <br /> —— ---- <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: .-t �r Hand Sink: v�J 'F Chlorine: ppm Heat: 'F <br /> Exp.Date: t_Z /-1 _ ( arewashing Sink: 'F Quat.Amm.: ppm Other: 'F <br /> Received By/Title: <br /> EH Specialist: Phone: 4(62� �3zlUS' <br /> Time in: 1 %90 Time Out: 2 o Page-0 <br /> EHD 16-24 (201 pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION. <br />