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,oe.4 .�oG SAN JOAQUIN COUNTY <br /> ? ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • Cq., „�P Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.sjgov.orD/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: z <br /> Address: '] O City: O CkT04 <br /> zlp Code: <br /> 42 <br /> 50 <br /> Owner/Operator: -phone:�^� 1 �OG Telephone: <br /> Program Element: 7 3 ProgramRecord: FO G Z-7 <br /> • Inspection Type: i0 <br /> BI80 Posted Yes t/ No Permit Posted Yes No Re-Inspection on or After: <br /> Al A- 1/104'09 T'i o <br /> 1,L,& 1i�750 c i L I r k 1711 <br /> lNCo <br /> 6-o 10<9s <br /> CI S L CD D <br /> c GO 7Obscl <br /> /S5'U& Z-3 e EWE41t7' evv G� P�t2A1 s <br /> FIFeF 15 PAio. <br /> i <br /> item/Loeat(oh. .emperet orf- - Temperature" <br /> .4i r- p rep <br /> S-f <br /> Facility Hot Water Temperature Yewashing <br /> Name: �ocv— RTG� Hand Sink: I ap aF Chlorine: .-2 iy-t ppm Heat: 'F <br /> Exp.Date:D Z7—�r77 oto `CO arewashing Sink: Z of Ouat.Amm.:v�V ppm Other. aF <br /> Received By/Title: [r <br /> EH Specialist: CI✓M URjb Phone: <br /> Time in: i O4' Time Out: Page,2of <br /> O ♦ /1 <br /> EHD 16-24 (20°pg) 4/3113 FOOD PROGRAM OIR CONTINUATION <br />