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SAN JOAQUIN COUK�" <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 /> ame of Facility: 0,4,R,01j JAW d Date: oZj / <br /> ddress: AJ2/'T City: 714Zip Code: <br /> wner/Operator: /vArstlz° G t.Z f Telephone: _ <br /> Program Element: Program ec df: 1 /g.� Inspection Type: / V/ PJ 6, <br /> 8780 Poste Yes No Permit Posted es No Re-Inspection on or After: <br /> )44` d7 Lir no Lzyo DF 2r fbo R\ � <br /> D 1 O G t /Zl 1 5-p <br /> o — <br /> S/U A'L1� J r 6. il-n14 F/•.oafL. 0�l <br /> EjLC4- FLS N it L A-il2 <br /> AV aT o 4/ - Sw/ — CE J 1 <br /> V VI <br /> 1iAGK/'tl Z f /RoVJAJ )Inc, t- <br /> ha D4,% 6-000 S AL.,- c6V'FR <br /> 6-rWCA 0 r—k <br /> i Cou ills <br /> an./J AC-; AWc.4i %ZaOew / S I vr0 ��ZJusfl i fa�L TD <br /> I n1 OF <br /> /U'GC t .J /C6- ACi*W.) ao J✓(.Ecu1L • F5tca12t A-U- <br /> - .u�S S <br /> S/<1 N e S A)A-5 vid — / iZ*7 iLL <br /> (,vr �W Ct1A�ts�l i} i!L /tilr'/60/�'G! 3 <br /> 120 L <br /> &I .J ° /0I2SINK. a T4 OAMK L07L J31.0p <br /> A, 4 � 5°F /76 9r— <br /> 6U� f) /- d—tlf l-v t r ;i'h 10 <br /> u � <br /> safety Cert Facility Hot water Temperature iN' . . .:,=... <br /> Name: Hand in <br /> Sk: `F Chlorine: PPmHeat: "F <br /> Exp.Date: warewashing Sink: "F Ouat. Amm.: PPM Other: -F <br /> Received By/Title: <br /> EH Specialist: 1 — Phone: <br /> Time in: .105, Time Out: , O Pa of <br /> EHD 16-24 (2n°Pg) 4/3(133 FOOD PROGRAM OF CONTINUATION <br />