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SAN JOAQUIN COS CY <br /> N: :t <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton 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: � Cl�il�% ON 6� � Date: 2 <br /> Address: \1G� �1 ( � r1 City: Zip Code: <br /> Owner/Operator: CfiZA�� f 1t�1 �� Telephone: a P— _ '3 <br /> Program Element: Program Record: YK ) Inspection Type: �1„ <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> o <br /> N, WOO <br /> �A <br /> Nk <br /> 6 <br /> I t I _ gvvi Cal C WOzS <br /> Name: Hand Sink: of Chlorine: PPm Heat: of <br /> Exp.Date: arewashing Sink: of Quat.Amm.: PPm Other: of <br /> Received By/Title: <br /> EH Specialist: Phone: ' L i1 CA GLD — 2 hrt <br /> Time in: Time Out: �`T Page of <br /> EHD 16-24 (2na pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />