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SAN JOAQUIN COU1. <br /> p .. <br /> ?+ ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.s'gov.org/ehd <br /> %FORD <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: '— Date: <br /> Address: 22NA2 C ICA City. Zip Code: 9 -7-7 <br /> Owner/Operator: Telephone: �3r ._9 <br /> nctn <br /> Program Element: Progra Record: Inspection Type: <br /> SZbrtj J <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> In NI <br /> \ . <br /> 2Sn f Qr i q �{ <br /> c Z,--, <br /> \ 01 <br /> u l 51n ( C <br /> `tom_ s b C <br /> O 9-411k b <br /> Item/Location Temperature Item I Location Temperature <br /> 3 <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: \0,-A of Chlorine: ppm Heat: of <br /> Exp.Date: arewashing Sink: of Ouat.Amm.: ppm Other: of <br /> Received By/Title: / <br /> EH Specialist: 1 Phone: '-A b v <br /> o� Y1 <br /> Time in: ` • Time Out: \ \ Page,of <br /> EHD 16-24 (2nd pg) 413113 FOOD PROGRAM OIR CONTINUATION <br />