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SAN JOAQUIN COUNTY
<br />ENVIRONMENTAL HEALTH DEPARTMENT
<br />1868 East HazeIton Avenue, Stockton, CA 95205-6232
<br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sigov.org/ehd
<br />FOOD PROGRAM OFFICIAL INSPECTION REPORT
<br />Name of Facility: i V\-Ncy-N \---\\-_-1,- QL,-.7 0 C -F-i\--A Date: (cy. ( _ 2
<br />Address: City: Zip Code:
<br />Owner/Operator: Telephone:
<br />Program Eleme‘ntri‘b 2 i 1 b ci t ogram Record: ,5-,A 2 03_2_ / 3 .,‘ a 0-7 -?7, Inspection Type: t2z\t__Q -_i_ ..:_
<br />SB180 Posted Yes NO Permit Posted Yes No Re-Inspection on or After:
<br />OBSE vATIoNutio cpiTiguivE ACTIONS
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<br /> .. Safety Certification Facility Hot Water Temperature 411, Warewashing lionmel
<br />Name: Hand Sink: o F Chlorine: ppm Heat: °F
<br />Exp. Date: Warewashing Sink: o F Quat. Amm.: PPm Other: °F
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<br />Received By / Title: 1 • I, i i---L-L--)
<br />Phone: 2_00t- to k ‘,3 -- EH Specialis cr.4.00.4.‘r_e_ (-;, * V--\ CNc•-•9---2...
<br />Time in: Time Out: k 0‘.•-(.5c, Pagkr
<br />EHD 16-24 (2nd pg) 4/3/13
<br /> FOOD PROGRAM OIR CONTINUA
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