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,pPa coa SAN .JOAQUIN CO` TY <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.orglehd <br /> L�FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: I 71 <br /> Address: f17) 1,4— city: Zip Code: <br /> Owner/Operator:(/ Telephone: <br /> Program Eleme t: -Program RecordInspection Type: <br /> SB180 Posted Yes No Permit Posted Ees No Re-Inspection on or After: <br /> QBSERYAT1flNS ANL?C{7RFiEC�IVE AC3lC7N5 <br /> �. � <br /> --e... .................. GL G�vi 'owo - <br /> - <br /> ry <br /> 10 <br /> -711 V 10 (thtf d Pill <br /> 11 r I <br /> dA'ur C1 <br /> n G'• �u <br /> ZAA <br /> _ _ o <br /> _ LLY114994 �c Un <br /> -� _.._ <br /> i <br /> tiD <br /> Item/Location Temperature ' Item I Location 1 Temperature <br /> i <br /> I <br /> i <br /> Food Safety Certification f Facility Not Water Temperature Warewashing <br /> Name: Hand Sink: of Chlorine: PPm Heat: 'F <br /> Exp.Date: arewashin ink: of Ouat.Amm.: PPM Other: of <br /> Received By/T tie ' <br /> G� <br /> EH Specialist: Phone: <br /> Time in: + Time Out: Page of <br /> EHD 16-24 (2n°pg) 4/3+13 FOOD PROGRAM OR CONTINUATION <br /> C <br />