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oP4`'1N SAN JOAQUIN COUNT ir <br /> �.• •.a <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> • c..• _. �P• Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.slQov.orq/ehd <br /> '9Cj F ORS <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: <br /> Address: -32-1 (4 a u - -0— City: c,l- f-z- Zip Code: 01 520 <br /> Owner/Operator: LkA— 0 a Telephone: K_3'V-3 <br /> Program Element: I Pro4hm Record: S Inspection Type: -zn 1 � <br /> SB180 Posted Yes ❑ No Permit Posted r,9 ❑ No Re-Inspection on or After: <br /> r;o BSK . .ERVAT(UA *E ACOWiwi"„ <br /> n . <br /> b h41k7 �Pls <br /> Q1 la0,-- szy r <br /> .7Gtc4i S 4ome r dar cz <br /> b) <br /> r 'rs- i h o d a 14 ! <br /> r rni e kt,� L.e._ 5 hall icy c <br /> E o C� uJ <br /> pre 0O W <br /> �u a u <br /> re l <br /> s <br /> d Y-" 7) 4zx-4'I 4-616.6r <br /> ccs p .s <br /> dc-Lo un r <br /> �'Vto Ccs A.e amu <br /> Lf-20-/( <br /> ItemJLocationTem erature Item/Location Temperature Item/Location Temperature <br /> r <br /> 31°f' <br /> s <br /> 0 <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: of Chlorine: ppm Heat: of <br /> Exp.Date: Warewashing Sink: of Quat.Amm.: ppm Other: of <br /> Received By/Title: e <br /> EH Specialist: Phone: <br /> Time in: /; Time Out: I` Page of <br /> EHD 16-24 (2n°pg) 11/2/09 FOOD PROGRAM OIR CONTINUATION <br />