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P4"'" SAN JOAQUIN COU& <br /> �O.�.COG <br /> N: X <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • �4.., s,.�,yp• Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.so_ ov.org/ehd <br /> �lFOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: ^' <br /> Gi;; ,) ca _ Date: , <br /> Address: i2 q G _ S City: �j / Zip Code: g554, y <br /> Owner/Operator: ' _TQ n l ,G we,- Telephone: $3S_1 .3) 2- <br /> Program <br /> Program Element: r 2 S Program Record: 1! 2 �. Inspection Type: <br /> b P C o <br /> SB180 Posted i Yes D No Permit Posted Yes No Re-Inspection on or After: <br /> zg h <br /> -�` IS� 1MrT71�y��./ i/'� ,�� �_c�y'a� <br /> .: . i�"�� c SIw st� <br /> I9 4 W 5 lore d G b c .c e&4( - Id- eP1# <br /> iit <br /> �GrC Y u w S e I re d . 410-2 00 ds, (eirec4 <br /> 0 &1 <br /> Item/Location Temperature Item 1 Location Temperature <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: --r J Hand Sink: of Chlorine: ppm Heat: of <br /> f r Go -- <br /> r it h - — -- -- - - <br /> Exp.Date: / Warewashing Sink: of Ouat.Amm.: ppm Other: of <br /> Received By/Title: b <br /> EH Specialist: - Phone: <br /> Time in: 1; Time Out: Z U !7 Page, <br /> EHD 16-24 (2^1 pg) 4/3/13 , FOOD PROGRAM OIR CONTINUATION <br />