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oP SAN JOAQUIN COUIOY <br /> .Z� ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax: (209)464-0138 Web:www.s*gov.org/ehd <br /> 4�/FOfR t� <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: r Date: •x.ac) 3 <br /> Address: 30,8 O C-A C' City: rl Zip Code: <br /> Owner/Operator: a C,"'C m Telephone: q 78—/0// <br /> Program Element: Program Record: fz-0'5;L7 9 Inspection Type: 12-0,J- -H <br /> SB180 Posted Yes - No Permit Posted Yes No Re-Inspection on or After: <br /> zoo/ 6 r P o r-e- or y me a.- d pp,,t <br /> h M/- rm,r' fi) D,S Orf C.C> CAP 4 ' <br /> Item/Location Temperature Item!Location Temperature <br /> Food Safety Certification Facility Hot Water Temperature "Warewashing 4='' <br /> Name: Hand Sink: 132^ OF Chlorine: �U ppm Heat: OF <br /> Exp.Date: Warewashing Sink: 13.2 of Ouat.Amm.: ppm Other: of <br /> •r <br /> Received By/Title <br /> EH Specialist: �^ Phone: <br /> Time in: 10.36 Time Out: P.M Page2f <br /> EHD 16-24 (2°'pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />