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1868 East HazeIton
<br />Telephone: (209) 468-342
<br />, Stockton,
<br />ax: (209) 464-0138 We
<br />95205-6232
<br />www.sicov.orgiehd
<br />FOOD PROGRAM 0 TION REPORT
<br />SAN JOAQUIN COLA
<br />ENVIRONMENTAL HEALTH DEPARTMENT
<br />Name of Facility:7
<br />(ZY,)_ZY,d-l<- Date:
<br />Address:Zip Code: RC:2./ /*:1%,22":2 CC., City:
<br />'-,2•76 .
<br />f77/ Owner/Operator:4
<br />/, #1,---,2-96 /oe Telephone:
<br />Program Element:
<br />"10,4?' .6,..0 5 Program Record: -",,fclo 77,..9 Inspection Typey"
<br />
<br />C C3 • - ',',/c ":4.:.i.0 r l
<br />./
<br />21,
<br />SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After:
<br />OBSERVATIONS, AND,coaREcilvE,,Aq,,
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<br />Itern/Locatiph, emper ur '*'-' Item / Location Temperature
<br />Food Safety Certification Ic,Iity Ho!.t/81,8q_erpRerature Warewashing
<br />Name: 4 y z , Hand Sink: /-..c:‹ c)19 0F Chlorine:
<br />42e-.7cid/ ' P
<br />Heat: 0
<br />Exp. Date: Warewashing Sink: 0 Quat. Amm.: PPm Other: 0
<br />Received B r / ..---- LUIS Ati-r-,vArNoo 41 vOhtz..
<br />EH Spec , '11:••'--- `.1"" .OPF
<br />Time in:
<br />9.
<br />Time Out: Page of
<br />END 16-24 (2., pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION
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