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SAN JOAQUIN COUP <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> c4�/FORa�P Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.s'gov.org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: f I <br /> Date: 7 <br /> Address: Z m ".-- City: Zip Code: <br /> Owner/Operator: C d j Telephone: <br /> Program Element: Program Record:JL Ins cion Type: <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspectibn on or After: <br /> I")-P+ <br /> `! Yt <br /> r G <br /> " l P1 1 <br /> G �Cao if <br /> a <br /> U 114111A <br /> Item/Location Temperature Item/Location Temperature <br /> Vl)yvy <br /> S e- ypyy11w 3 LO <br /> Food afety 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 /> Time in: j r Time Out: aPage <br /> EHD 16.24 (2-pg)4/3/13 FOOD PROGRAM OIR CONTINUATION <br />