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SAN JOAQUIN COUK <br /> p y-� ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> �4�IFO ��P Telephone: (209) 468-3420 Fax:(209)464-0138 Web:www.slgov.org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of f=acility: 'Date: <br /> Address: Kt <br /> City: Zip Code: <br /> Owner/Operator: *t g� 1W Telephone:510 --11-6---79ti <br /> Program Element: Pr ram Record: Inspection Type: <br /> 581 BO Posted I1 Yes I7 No Permit Posted ❑Yes ❑ No Re-Inspection on or After: <br /> x >: >' flBSEROf1d+�NSAQ' iRR �G:T# 11C9 � <br /> ,.,.,. <br /> ( W <br /> .W t ,, 5(A k- 1 — f I 1VI 8 <br /> y W wca A t 010t%&V14 <br /> z Pr (� <br /> '3 a 16 rr f <br /> S6, IF <br /> l�L{s C�2c. <br /> I <br /> rr'ee ter41—p— 6,PJ mi ` 'F <br /> a <br /> t tut/�a61e ka4e nq gSa r <br /> jar S' <br /> F. j <br /> CC49?- 4-0 <br /> Q ltemll.o�a3�on aTst>� ef�ture :,. d Itiarii tLodafao�r ,., Tertiperature; <br /> s. <br /> Food Safet Gertd;ctaon "` acil Hot'YVatergm era#ury 1►itarewastai <br /> ° +... p. <br /> !Name: Hand Sink: of Chlorine: ppm Heat: -F <br /> �r <br /> Exp.Date: WFr washing Sink: of Quat.Amm.: ppmOther: -F <br /> Received By 1 Title: <br /> IL A <br /> EH Specialist: ji Phone: 2 k <br /> Time in: Time Out: ✓ Page of <br /> EHD 16-24 {2n°pg} 4/3113 FOOD PROGRAM OIR CONTINUATION <br />