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SAN JOAQUIN COUK <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.slgov.org/ehd <br /> L/FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: ' Date: 11 <br /> Address: � � Ll 4 t ,\ (It <br /> City: rv1 C Zip Code: A u <br /> Owner/Operator: •3- 1 S Telephone: / <br /> (fir z � s C 0 LL(_ �3U- YY 71 <br /> Program Element: KI %4 Program Record: S 1 6 14 Inspection Type: C .�r e< I'c 11 <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> 05 F j 010 v+-1rrec k-d e ycefi <br /> W 11 - � 11AJ built/-u <br /> Cleo n fe,J.Y. •1 <br /> Ghc r ts roc.ei a x h 4, LA1a <br /> ,2 ,.. <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 Ouat.Amm.: PPM Other: of <br /> Received By/Title,: � <br /> � � <br /> .. <br /> EH Specialist: _ Phone: <br /> 4/61-• <br /> Time in: ' 0 o Time Out: A Paged of <br /> EHD 16-24 (20°pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />