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a4�n. SAN JOAQUIN COUt." <br /> ?a ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • 64..., :P• Telephone:(209) 468-3420 Fax:(209)464-0138 Web:www.s0gov.org/ehd <br /> G/FdP� <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: r K,1T * O 7j(Q - Date: "A I_W/ 13 <br /> Address: 41 S. �-Mly aG vc City: S1 CXAn1 zip Code:hone:Telepq�IS <br /> o !1 <br /> Owner/Operator: 1 1C/ C �W \\ \N UA63- QQ OJ <br /> Program Element: 1 to W Program R cord: LUW?­)-+ (J1 Inspection Type: LQm 10, <br /> 8180 Posted Yes rl No Permit Posted ❑Yes ❑ No Re-Inspection on or After: -- <br /> cm �a1�+ ust can cwt n r �r�t\k area h u mold -_AJ <br /> i uz cX12 Arn `9Gcy- NK M06 an -V . 7 <br /> - OP-y' v game and ah 1yle -rru fi sada Ines . <br /> lvxe cid aQe <br /> Md not obs r CYT\ n4W�' <br /> *b �C) nob o v.e n rnokA on -Che 1 C)Q012 Urn Une StO k_ <br /> C)T anme1 c2 ('rgpm acb-kw . <br /> O rt�, of -rhe sada aa'IliV S and MW 0-k�-4( n <br /> ftl CA1� <br /> Name: Hand Slnk: -Fhlorine: Tm eat: "F <br /> Exp.Date: arewashing Sink: "F uat.Amm.: ppm the <br /> r: `F <br /> Received By/Title: <br /> 1,G— u i <br /> EH Specialist: Phone: 2w- <br /> Time <br /> 2yrime in: (L) • d'dTime Out: `0 . 1"i Pagel oft <br /> EHD 1624 (2b Pg) 4/3/13 FOOD PROGRAM OF CONTINUATION <br />