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�O.p`•Q .C�G SAN ..IOAQUIN COUh. <br /> y� ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> . c... ;p• Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.si4ov.orq/ehd <br /> 9L�FORi+ <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: N 0 Date: 1 <br /> Address: 4S p £ /' ih S City: Tr c ( Zip Code: S3 76 <br /> Owner/Operator: Telephone: FIT- 711c <br /> Program Element: Program Record: Inspection Type: C"4) <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> z <br /> Build-u p I or, WoZ- n d I ci 41ra, clean <br /> co dav <br /> Ton O r <br /> tAS C „P or., ✓ r in I i&4 C:ii P., r,k <br /> u cis a or I a�c K of P) ca?rS . d <br /> la 0 <br /> Item/Location Temperature Item/Location 1 Temperature <br /> �u V r\ yr / <br /> .................... <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: / Bink: 'F Chlorine: m Heat: F <br /> N/k Kas 1/u.v)I 11 r pp <br /> Exp.Date: Warewashing Sink: of Quat.Amm.: ppm Other: of <br /> i <br /> Received By/Title: 77-71-777 <br /> EH Specialist: Phone: ��6f <br /> Time in: /v Time Out: 0:35 Page of <br /> EHD 16-24 (2nd pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />