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SAN JOAQUIN COI, Y <br /> 'oP. .......co <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax: (209) 464-0138 Web:www.sigov.org/ehd <br /> CIF'O'R�a <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: kaes M 2)�� can Date: 4t'ZrS_/) <br /> Address: 6,' P cn&C) City: StbC�tz� Zip Code: Qc)� <br /> Owner/Operator: wn , ua 1v Telephone: �1 - `i`J p h0� <br /> Z <br /> Program Element: 1('0`'L Program R ord: o t 1 1�l;. Inspection Type: R <br /> SB180 Posted es No Permit Posted ed No Re-Inspection on or After: <br /> �d ad ca4l f i CCA-WS Car.2 n of on g4e. w c n it 6 6 cA C <br /> a- <br /> oc a -h <br /> Item/Location Temperature Item/Location Temperature <br /> 'a-Ckr i ne <br /> Food Safety Certification _Facility Hot Water Temperature Warewashing <br /> Name: ,!Hand Sink: of Chlorine: Ii Ppm lHeat: of <br /> Exp.Date: IWarewashing Sink: 12 of Ouat.Amm.: PPM liOther: of <br /> Received By/Title: <br /> EH Specialist: G Phone: <br /> I —A -}- <br /> Time in: 1� Time Out: ; i1_o `p P <br /> 'TageZof <br /> EHD 16-24 211 pg) 4%3/13 FOOD PROGRAM OIR CONTINUATION <br />