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SAN JOAQUIN COUR <br /> 4 ENVIRONMENTAL HEALTH DEPARTMENT <br /> x <br /> _ 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.sigov.org/ehd <br /> ��FOft <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: ' ti� ��� Date: 17 1 7-71-e7- <br /> Address: 1 City: _.1 r i d� Zip Code: <br /> Owner/Operator: L �i1 Telephone: 3�q <br /> Program Element: ,t� Prograiin Record: 'l02 b, Inspection Type: <br /> SB180 Posted es No Permit Posted Yes No Re-Inspection on or After: <br /> OBSE4 �1. t+l <br /> 4 <br /> y y s <br /> �� I"[iiiTy���l <br /> C l-Q.o-•nh�—k VQ Jr� a- _� <br /> Civ—c't �o�-•�\_.... <br /> l� m a.�Ir`=.r-e � S �1�l F• P�'.,�.'�C -�\-�o _��-%��z �� o.,:n _. _ c �� <br /> y1 <br /> v�4-:' <br /> I' <br /> s � � <br /> �� Q( `2 <br /> -2Q C'� �2 <br /> _ ___s:,�_n�-�_��•�2.—____�-�<--.yea `Frew, -C-�.�.l�� -�-,7�,�, . <br /> c V­�r--e. '-i I F <br /> Item/Location Temperature Item/Location <br /> tura✓ <br /> Z>9 f7 <br /> F <br /> Food Safety Certification Facility Hot Water.Temperature _ Warewashing <br /> Name: Hand Sink: OC °F Chlorine: Ppm Heat: `F <br /> Exp.Date: ar washing Sink: �2?) �F Ouat.Amm.: '-AO-D ppm Other: aF <br /> Received By/Title: <br /> EH Specialist: - Phone: A 101i3— <br /> Time in: 53 Time Out: Pa" ` <br /> EHD 16-24 (2m pg) 413/13 FOOD PROGRAM OR CONTINUATION <br />