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O4"'"�. <br /> SAN JOAQUIN COUN <br /> � CSG <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> In: X <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • -., t ;P• Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.slQov.orq/ehd <br /> 4�;FaRa <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: 074- 77 / 7 T7A;t 7 <br /> Date: 7 `C <br /> Address: 30k 0, <br /> 4 tall ity: Zip Code: ^ _ <br /> Owner/Operator: /! �Pv u r it_ Telephone: / <br /> Program Element: Program Record: Inspection Type: <br /> �7 <br /> SB180 Posted Yes ❑ No Permit Poste Yes ❑ No` Re-inspection on or After: <br /> r <br /> r <br /> / r N <br /> J <br /> vlh( n <br /> Cd 144, ilultdae <br /> ►� S' <br /> 4.1 tits_ ( 1, - 01)ro Ch v_ 10-c <br /> Item/Location Temperate a Item l cation Temperature <br /> r� �;1✓! [ <br /> G <br /> S)'914- L ------ %� <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: F Chlorine: ppm Heat: �F <br /> Exp.Date: Warewashing Sink: of Quat. Amm.: ppm Other: `F <br /> Received By/Titl0 <br /> EH Specialist: Phone: <br /> Time in: / 0'9) Time Out: Page of <br /> EHD 16-24 (2nd P9) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />