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SAN JOAQUIN COUN' <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.sigov.org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: 4 Date: <br /> Address: r.,,Qr City: 1 _h Zip Code: <br /> Owner/Operator: L�✓r h Tt7 Telephone: <br /> Program Element: 2S Program Record: Q (C=-,z U� Inspection Type: <Zcjc.k <br /> t^a, <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> Tk <br /> 1' 1 CQ rec, i ect(A46( 2Q 1� <br /> vy nCa 40r 5 <br /> r- � e� f�kln <br /> o F�' <br /> FED TIS ` c-A0 r 15 A-4- 60 11 CNA Q <br /> Z 711 lujtyi— QJe r I�S L r-o � i • wa( -c ver--. Pry <br /> o� �� &, C,bl� bel6 6 2 d s <br /> fJPs 0. t!�O C�V C h <br /> c�.r 5 JcJ 1'v4� cLC.�� �(•1 1•rte G ^ 1-�. � <br /> Item/LocationTemperature 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: <br /> P y ro '16-3 Nye <br /> ime in: 10: 30 Time Out: 'Z : l Page3of3 <br /> EHD 16-24 (2nd pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />