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4 <br />SAN JOAQUIN COUNTY <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.sioov.org/ehd <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />Name of Facility: ^ <br />Date: <br />ddress: - City: <br />fy-Z• l7 Zip Code: <br />Owner/Operator: v G r <br />Telephone: <br />Program Element: /n Program ecord:fFGs� <br />u' ! <br />Inspection Type: <br />6t 80 Posted Yes No Permit Posted Yes No <br />Re -Inspection on or After: <br />�[ <br />s< <br />L <br />r.� <br />av�s� <br />u <br />cCe a vt t I <br />1 <br />r, s a rin �vwrtiwl n <br />acv a� - 36D -4 <br />O '" B <br />a ✓ <br />i/1tt1yWAk`l Dnp vtk 'I vvf <br />Vl1 bJ►V� l V c <br />WI. (4rw -`iDOL <br />� <br />V"AiV rlyky' W r-Y4"Vt L� <br />InlC1ow - IVI 1 /1_a�- <br />dlr <br />Sq1y1dM <br />rle_�-to I u— e vwt <br />— <br />At -� Ivl Vr l MAkr- 3 F <br />v — 3-7F <br />+ o a✓ tt I 33 <br />u✓ yCD c —/rt — 33 <br />+10(51n, <br />fup <br />7' <br />Tvl�cYiF <br />dr <br />Facility Hot Water Temperature _ Warewashing <br />Name: p Hand Sink: of Chlorine: ppm Heat: <br />of <br />Exp. Date:'C p <br />arewashing Sink: <br />'F uat. Amm.: ppm <br />Other: <br />of <br />Received By/ Title: <br />EH Speciallst: t <br />Phone: <br />Time in: T <br />03 <br />Time Out: <br />Page� <br />EHD 16-24 (2otl pgl 4013 FOOD PROGRAM OIR CONTINUATION <br />