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° SAN .JOAQUIN COUNTY <br /> 'gyp.......;.0 <br /> � •.OG <br /> r. z ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> c4 iP Telephone: (209) 468-3420 Fax: (209)464-0138 Web:www.sogov.org/ehd <br /> ��FORl� <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: <br /> J <br /> Address: -53 <br /> 7 d _ City: Zip Code: <br /> Owner/Operator: xr-ek-11" � / /(� Telephone: <br /> Program Element: (Q S Program Record: Inspection TypeIS Z <br /> 6180 Posted ❑Yes ❑ Rermit Posted es ITI Re-inspection on or After: <br /> wt-0 - CUA 064 Az PuAgk <br /> 0 +vqd aalw Aw w e reap-- <br /> Wnb J_Au(/w NO --ea <br /> 101 I&IA <br /> e� <br /> a <br /> a <br /> r <br /> 0A^ a, vVt <br /> u <br /> C& ✓1 <br /> r4 . N I V <br /> ,u cew ;I-P4 c,e <br /> vY\, <br /> W, TemperatureItetn I Locaon i T erature' <br /> a_c� 0 r A be <br /> Int e' � 3 <br /> Yf <br /> 'Cty Hot Wates, mperature Warewashing <br /> Name: ^ .,�1 i� - yt)r Hand Sink: of jChlorine: ppm iHeat: of <br /> - <br /> Exp. Date: arewashing Sink: j 1 pP <br /> °F !Quat. Amm.: m (Other: 'F <br /> � <br /> Received By/Title: <br /> EH Specialist: Phone: <br /> Time in: Time Out: Page-A, 3 <br /> =-1G 16-24 (2nd pg) 4'3'13 FOOD PROGRAM OR CONTINUATION <br />