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SAN JOAQUIN COUr <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> N: :: X <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • �q.. 3.�;;P• Telephone:(209) 468-3420 Fax:(209)464-0138 Web:www.s'gov.org/ehd <br /> ��FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: SC t Date: - 13 <br /> Address: 2_2,3 S �^ G City: ► _^ n Zip Code: Ct S 2-1-A O <br /> Owner/Operator: 'K' 77S\\ ; �CJ� Telephone: ': l; I _ Al2 <br /> �S <br /> Program Element: b P ogram Record: `bO 1 S� Inspection Type: <br /> SB180 Posted L Yes ❑ No Permit Posted Yes ❑ No Re-Inspection on or After: <br /> w <br /> CO Q5C15 3'i © l -X3 C 'S <br /> 2 C ra.,J\\ o Z roc, <br /> O C `v- <br /> � a r <br /> .v <br /> 2 <br /> r � li <br /> �' <br /> Item/LocationTemperature lfem/Location Temperature <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: of Chlorine: ppm Heat: of <br /> Exp.Date: Warewashing Sink: of 11 Quat.Amm.: ppm 11 Other: of <br /> Received By/Title: ' <br /> EH Specialis Phone: \,t b _ JO <br /> Time in: 1 I- \2- Time Out: V. S Z Page of ' <br /> EHD 16-24 (2nd pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />