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�3 0.P4 .0 SAN JOAQUIN COUN <br /> y-+ 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.orp/ehd <br /> 4Ll FOfta <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: ���� - L \-�(-_, \,) (V Date: 1 0—?j- 1,-4 <br /> Address: 2 i City: (_�3C-1 ; Zip Code: q S Z�lO <br /> Owner/Operator: /� viV NS Telephone: <br /> Program Element: Program Record: ` ©b3� Inspection Type: �sZ <br /> SB180 Posted es No Permit Posted Yes No Re-Inspection on or After: 2 . <br /> 2 -C 2 C L1J <br /> A <br /> w <br /> C'X k 00 <br /> rN c, i me <br /> tel_ <br /> Item/Location Temperature Item/Location T Temperature <br /> SD t= 2ti'� 3 <br /> -- <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: v n \ H 1�d Sink: —I� �F Chlorine: ppm Heat: °F <br /> Exp. Date: _ V Q, W ewashing Sink: 121 aF Quat.Amm.: ppm Other: �F <br /> Received By/Title: CCJJ <br /> EH Specialist: Phone: ,2)—o <br /> Time in: 1` Time Out: —.ry\ Page-2f Z <br /> EHD 16-24 (2^d pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />