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P41'" SAN JOAQUIN COUP <br /> y-+ ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> . r.. �P• Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.sogov.org/ehd <br /> 4 C%F O'itta <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: kk4' ` .t_•fi 1/14 / Date: <br /> Address: a City: S_7404�:K2�2 Zip Code: c���p� <br /> Owner/Operator: T lephone <br /> rnl /hl��� _ io 15-95< <br /> Program Element: /j/i, Program Record: /� y?8�� Inspection Type: {mom <br /> B180 Posted Yes No Permit Posted Yes C No J Re-Inspection on or After: <br /> 5,0_ fSERiiTTK� QtEC�Iir <br /> J u�>' har hd-c lam t> h o 4- l �Lem <br /> i v o o)c <br /> Yo <br /> r r� a. CS hod- 1/ 7 � �— ex,� / oo - <br /> jn o <br /> ro V-1 Ide Cxr '7-" <br /> c, <br /> W <br /> G <br /> u-H-eY he44tr At oin C I J42 a Ke 5 y r <br /> Ty O i-t)o.e r 04 r <br /> Item/L ocat crt a Temperature item t Location Temperaturt. <br /> r �7/z�r`� f � <br /> awi'�'a, 8 <br /> Po rk 13r <br /> f ts� <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: of Chlorine: ppm Heat: of <br /> Exp.Date: arewashing Sink: of uat.Amm.: ppm ther: 'F <br /> Received By/Title: <br /> EH Specialis • Phone: i <br /> ime in: Time Out: / Page pf <br /> r <br /> EHD 16-24 (2'd pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />