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aU�N SAN JOAQUIN COU N'Y <br /> a' ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-623 <br /> • �Q,.s "�;P. Telephone: (209) 468-3420 Fax: (209) 464-0138 Web:www.s ov.or lehd <br /> :F <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Date: <br /> Name of Facility: h�10 Jl[��C-`�ti E <br /> �{J�.'Tol_\ Zip Code: <br /> Address: <br /> D Uh�n � - �1 h um�t5�+ City: C7• <br /> Owner/Dperator: 212-2 '7o r� W O� <br /> Telephone: S �oo <br /> � <br /> Program Element: cj Program Record: 0,111016 �r� Inspection Type: <br /> SB180 Posted es n No Permit Posted es n No '"1 Re-Inspection on or After: Y----IN Mi � <br /> re art; <br /> MCC' irk OCI -Fi[ �'Co. <br /> `vc?c S n kfVP 121 -CkTtA s°,nk` <br /> 111�1i Q_ r _ to ak <br /> oh5, -e/ry-ecl u . <br /> J UD ?U i 4 P-1 SkCt 17J alb e. ' ce(, <br /> pPrv�uvi `n , o� � � aVO i CAKQ_ i nom► h a <br /> c - (A <br /> r e. <br /> cm,L� <br /> 1NCJi 1\�L <br /> bat- O <br /> lRY3100 17MM WWWW <br /> Name: Hand Sink: f U G of Chlorine: ppm Heat:11 `F <br /> Exp.Date: ar h' g Sink: �•�� 'F Quat.Amm.: ppm 11 Other: 'F <br /> Received By I Title: <br /> EH Specialist: Phone: <br /> '10c( /f,Qi-)_- . <br /> Time in: i U Time Out: ` 0° Pagq Of-Z <br /> EHD 16-24 (2'd pg) 413113 FOOD PROGRAM OIR CONTINUATION <br />