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SAN JOAQUIN COUP <br /> A <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax:(209) 464-0138 Web:www.siaov.org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: 12, y�,71 Date: Z Z Ll <br /> Address: 1 ) �I City: Zip Code: <br /> Owner/Operator: P7 Telephone: <br /> Program Element: C' z� Program Record: /, Inspection Type .r,, , C / <br /> SB180 Posted Yes No l Permit Posted Yes V No Re-Inspection on or After: -�1�1� <br /> via at, . <br /> Id ct <br /> Item/Locati/o�n Temperature Item!Location Temperature <br /> 41,14- i4111 46�xz 14) <br /> 3 F - 4 <br /> -S f <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: - G� ��� Hand Sink: Q of Chlorine: ` ppm Heat: - of <br /> Exp.Date: Warewashing Sink: of Quat.Amm.: ppm Other: of <br /> 62 <br /> Received By/Title <br /> EH Specialist: Phone: c` _ <br /> ` <br /> Time in: ,-q(, Time Out: T Pagezof Z <br /> =HD 16-24 (2na pg) 4/3/113 FOOD PROGRAM OF CONTINUATION <br />