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SAN JOAQUIN COUP <br /> y. X 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 /> l/ppR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: 'j G nvS ��l Date: ,C <br /> r <br /> Address: �1:, �� I, City: � -�r� Zip Code: n �O <br /> Owner/Operator: M 0 R�fi _f Telephone: <br /> Program Element: �j�(� Program Record: Inspection Type:IS - � <br /> 6180 Posted ❑KYles ❑ Rermit Posted :l es ❑1 Re-Inspection on or After: <br /> �5 <br /> e*V <br /> wt 4- Qcavps . use te-n n <br /> SC h <br /> Item/Location Temperature Item l l oca _j ure <br /> Ali. . :.. <br /> Food Safety Certificationig&cility Hot Water Temperature �Warewashing <br /> Name. v L and Sink: of (,Chlorine. ppm Heat: IF^: <br /> Exp.Date: Narewashing Sink: 'F Quat.Amm.: ppm Other: of <br /> Received By/Title: <br /> EH Specialist: Phone: ' 4Lo _ <br /> Time in: 2 Time Out: U.GtV (/ Page l f <br /> � v I <br /> EHD 16-24 (21 pg) 413113 FOOD PROGRAM OIR CONTINUATION <br />