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SAN JOAQUIN COUF <br /> N: X <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.sigov.org/ehd <br /> ��F'ORa <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: G Cat. c, Fe si6 v`i Date: /c)r�2 _ <br /> Address: C, 7L_ City: `S,1L6C4'<' Zip Code: 1 15, <br /> Owner/Operator: lephone: <br /> Program Element: ProgramRecord: PA D. c_t, O 3 p D i7 Inspection Type: <br /> B180 Posted Yes No Permit Posted Yes No ! O Re-Inspection on or After: <br /> Aim <br /> ftm km <br /> WMM. El <br /> 5 <br /> t� <br /> � r <br /> h_ar P?c)kva_s h C;5 G'_�o GJ e 4 <br /> aAh b o <br /> �� a <br /> C4/2 m e <br /> 1 Li cam' o s a 7s 14' .-7 <br /> c--'-e-e kll_cz d a <br /> a /00 -- p R ! <br /> \ 0,01, <br /> 4 s ,ON 0311, <br /> 77 <br /> Name: Hand Sink: of Chlorine: ppm Heat: of <br /> Exp.Date: arewashing Sink: of Ouat.Amm.: ppm ther: of <br /> Received By/Title: <br /> EH Specialist. Phone: / <br /> Time in: ` Time Out: y Page of <br /> EHD 16-24 (2nd pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />