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°"`"` SAN JOAQUIN COUI <br /> '� e <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> 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: rl Date: <br /> Address: -� ;/ City: Zip Code: <br /> Owner/Operator: "� Telephone: <br /> Program Element: /,.1_ ' Program Record: oyo 3Inspection Type:. J <br /> SB180 Posted 1(/ !,❑Yes ❑ Rermit Posted ❑Yes ❑I Re-Inspection on or After: <br /> r AVA <br /> r� <br /> r , <br /> �► /) <br /> e gt <br /> M <br /> iJ^�/�✓v v V I l <br /> r I f <br /> wpm oLi <br /> S <br /> r <br /> ....... _............... .............. ............_.._ _......__..... __. ____—__. ._—_....... ...._..__... .............-_.. . _-_ --_. ___ __.. _..... _.____ ......... -_.....__. <br /> .;r •,�;..�3n;4�sw�W e.;.,,.., ire' <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: k_7ts <br /> / <br /> Time in: Time Out: Pagel of� <br /> EHD 16-24(2ntl pg) 413/13 FOOD PROGRAM OIR CONTINUATION <br />