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4o,.P4 ..0 SAN JOAQUIN COUP ' <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • c... :P• Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.sigov.org/ehd <br /> 'PCS F'O'Rt•1 <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: ._/ L�\e(_� Date: 112Z/ <br /> Cit Zi Code: <br /> Address: a- �✓(I M.�`�1 .(�t�� y p C1 G <br /> Owner/Operator: 1 u' w� 1 Telephone: 4-W 6 <br /> Program Element: -Program Record: �? �• N. -- ��� Inspection Type: {zW"t-\z <br /> SB180 Posted ! Yes Ro + .� Permit Posted ' Yes I No Re-Inspection on or After: 1 i <br /> •,ki- <br /> "I Sffli <br /> e <br /> G (� �1' iv �1��1�G� C:j�;� OC�G� �w,',:� SUI <br /> in- F{' <ir" 11ut <br /> Item/Location Temperature Item/Locationmperature <br /> Te <br /> C <br /> 1 111_ �n C <br /> Food SafetyCertification Facility Hot Water Temperature Warewashing <br /> Name: u Hand Sink: of Chlorine:uamm. ppm Heat: of <br /> Exp.Date: Warewashing Sink: F Ot.A : ppm Other: of <br /> Received By/Title: <br /> EH Specialist: Phone: r L <br /> Time in: Time Out: . 7,� Page of,. <br /> EHD 16-24 (2nd pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />