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cSAN JOAQUIN COUPS - t <br /> X 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.orq/ehd <br /> �ikoRiN <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: ,I + N )V f rc/C )� Date: <br /> Address: / S S 1 S City: Z 1 \ r-c Zip Code: 9 S �3 <br /> G <br /> Owner/Operator: Telephone: 7104- <br /> Program <br /> l rProgram Element: Program Record: Inspection Type: C"a` <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> t <br /> q M 3 j- c, S: ) /'J ) r 4 /li 7 . <br /> a;A Co ILAJ m 4 O C4 Or o cize 12O f u1C., )'-CW). <br /> CC rreG�' r Ur <br /> Io <br /> r v; t�S V1l W 0M r^'3 4vcc'm re Cl a da <br /> Cl act rI i n e c 4,o- rf,120,1 a r S to,. <br /> 7a 1 VC1 <br /> f wJ C P 3 <br /> Item/Location Temperature Item!Location Temperature <br /> Food Safety Certification Facility Hot Water 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: L/b/ ,3�6 <br /> Time in: r Time Out: / Page of <br /> EHD 16-24 (21d pg) 4/3/13 J FOOD PROGRAM OIR CONTINUATION <br />