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SAN JOAQUIN COUI ' <br /> Z� ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax: (209)464-0138 Web:www.si4ov.org/ehd <br /> �1FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: <br /> -IL-I-15 <br /> Address: 2210 1.1—) CWYq'f City: Zip Code: <br /> (S'+'t>CCK-'tD A-) (�5 ZO <br /> Owner/Operator: o hnn'I-e— t Telephone: x(0-7 g� <br /> o <br /> Program Element: L�OZ Program Record: P 9_0 S05 3 I Inspection Type: i <br /> B180 Posted ` Yes ❑ Permit Posted ')c Yes ❑ I Re-Inspection on or After: <br /> - . OWN. = <br /> IM I <br /> 1 � 'FY� 1r�-"�r5 1 �r r►z o rne.-I-t✓� O Va� 5115 f Ij <br /> w-e re- eo r re-c4< e4 <br /> Item/Location (Temperature Item 1 Location Temperature <br /> Food Safety Certification Ft• Hot Water Temperature 11Yarewa <br /> Name: Hand Sink: Ch rine Heat: <br /> 'F ��.h 6-Z ppm - of. <br /> Exp. Date: re ashing Sink: of Quat.Amm.: ppm Other: of <br /> Received By/Title: <br /> EH Specialist: a Phone: <br /> Time in: y ,Z� Time Out: / ✓�:q(3 / Page! of , <br /> EHD 16-24 (211 pg) 4'31/13 �J FOOD PROGRAM71R CONTINUATION <br />