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SAN JOAQUIN COUP' <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> iP Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.slgov.orq/ehd <br /> /FORA <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: 'j P Date: 22 -Il <br /> Address: L q r^i Ve City: f r w f Zip Code: <br /> Owner/Operator: Telephone: /,y y <br /> Program Element: Program Record: Inspection Type: P ,A <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> e G 3 Cc,,o 5 •l )e w u Gi i'a i n C Gi r C1j <br /> C4C: / k H cis0jr r <br /> CC v6"Ll t r <br /> LCrre-e � ro(f - fo G i A 41 <br /> de Y i C& r,14 r PCr/o. cc-"'j <br /> 6 dc' <br /> SPry• , OIC r 6u 65 61 1 S ✓.- re Plbv;�e <br /> 1C US ")Ajhor <br /> Item/Location' Temperature Item J Location Temperature <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: V C ,� Hand Sink: jL ^ of Chlorine: ppm Heat: of <br /> 1J <br /> Exp.Date: arewashing Sink: I of Quat.Amm.: ppm Other: of <br /> Received By/Title: <br /> EH Specialist: Phone: /p <br /> Time in: Time Out: 3'. V'S Page of <br /> � <br /> E H D 16-24 (2nd pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />