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SAN .JOAQUIN COUP <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax: (209)464-0138 Web:www.si4ov.orq/ehd <br /> <<Fptt� <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: 1 LG% r)j Date: 2 <br /> ddress: ' r 1' nicA <br /> City: Zip Code: CI5 <br /> tn <br /> Owner/Operator: rilol/' Telephone: " <br /> Program Element: Pro-gram Re rd: Inspection Type:Is L n s? <br /> B180 Posted ❑Yes ❑ Permit Posted ❑Yes ❑I Re-Inspection on or After: <br /> IVA <br /> e OW, -Avc." Loi -ice _ U,cVonS re m <br /> R�GCA . <br /> SCS D-)- I bonvz , � CT) . <br /> 3 <br /> WO'da CA S0190N w AW obrwz co <br /> fti- cx- cojd \jq c;4e'�_ . pvice 0S CSS <br /> � u, �' '1 h X11�- - ►`cuS oC�l <br /> s crT\ Warn+gin e, " <br /> Item/L.ocationTemperature = Item I Luca#�s 1m raturg <br /> Temperature of Water Tem <br /> .- . pe � 114f�rewashing � "�" W <br /> Name: Hand Sink: of IChlorine: ppm Neat: of <br /> Exp.Date: arewashing Sink: of PP <br /> IQuat.Amm.: m lo ther: of <br /> i <br /> Received By/Title: <br /> v- <br /> EH Specialist: Phone: 9-CAL 4 r r <br /> Time in: I })L Time Out: 1 = ��1D Page)of 2 <br /> EHD 16-24 (2ntl pg) 413/13 FOOD PROGRAM OIR CONTINUATION <br />