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SAN .10AQUIN COL 'Y <br /> �.• � •.o� <br /> 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.org/ehd <br /> �/FORt•1 <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: (] - Date: l <br /> Address: City: Zip Code: <br /> Owner/Operato . pip/110 1 0� Telephone: ct <br /> Program Element: _S-Program Record: Inspection Type: <br /> SB180 Posted Yes No Permit Postear <br /> es No / Re-Inspection on or After: <br /> Vl <br /> 0 l ✓ (.l I'�J - 3 <br /> Lh <br /> � Uini� �S <br /> wa . A <br /> ,f 3 7 <br /> Item/LocationTemperat re Item/Location Temperature <br /> I �GC �1 C 0 �uv w <br /> lit C 19k' /� c 3 �'FAt a 01 rt, <br /> f-I sly 3 0-e v- fi-v - - q <br /> r <br /> acyt .Hof Water Temperature Warewashing <br /> Name: i Hand Sink: of Chlorine: ppm Heat: of <br /> Exp. Date: arewashing Sink: of Quat. m.: v ppm Other: of <br /> Received By/Title. <br /> EH Specialist: Phone: <br /> Time in: Time Out: Page Zof> <br /> c li <br /> EHD 16-24 (2nd pg) 4/3113 FOOD PROGRAM OIR CONTINUATION <br />