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a"!" SAN JOAQUIN COU, <br /> ` X <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> W <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> �4..• .a�P Telephone:(209) 468-3420 Fax: (209) 464-0138 Web:www.slgov.orq/ehd <br /> L�FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: flecle R) 4), Date: 2 !/ <br /> Address: 2 Z D�UL16 City: SfiUC ficU� Zip Code: 11'52(,)to <br /> Owner/Operator: t `n Telephone: 41-1 <br /> Program Element: � Program Record: G`�� Inspection Type: l t� <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: 1 C D <br /> QBSEftyATIUN$ANR R QCTIYE GT#QN$ <br /> e,f -veCj Ob r(t-t- 10 i-►v e ddu It cared ba c�r�aac S <br /> i n e -\tCbon qnd Ckfew elxG1 Cc Vo S <br /> �, �( ,ri ��mG r► C1c)Wc) usnfi1 a wCad <br /> C) "1h 0 ytFiIi- v'ca+0T C\ fi 'Ch ?, Cy"P <br /> ----- <br /> 3 t h� CO2 'A-Ony- \S l o� - Sjzc,uf-e . SeCtAre A-bda�l <br /> Kpa Lo�atiott � ,, �� ..� �:�� •..,, , <br /> I <br /> Food,Sa#e# .C ►fi #ton h FaORY :a # i§ F. `Y <br /> Name: Hand Sink: of Chlorine: Ppm Heat: of <br /> Exp. Warewashing Sink: of Quat.Amm.: ppm Other: of <br /> I <br /> Received By/Title: <br /> EH Specialist: Phone: n ry7 6 <br /> Time in: ') :-))+ Tj Time Out: Page (of <br /> EHD 16-24 (21,pg) 4/3;133 FOOD PROGRAM OIR CONTINUATION <br />