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SAN JOAQUIN COUP <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax:(209)464-0138 Web:www.s4- ov.org/ehd <br /> ehd <br /> ��FORN <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: t, �V \ Date: ? ' <br /> Address: j o , City: �L� Zip Code: 9 5,7 <br /> Owner/Operator: a n A e n Co r Telephone: g 3y,O -1Y,6 <br /> r <br /> Program Element: ( ()() Program Record: O 6 Inspection Type: <br /> SB180 Posted Yes lb ()() <br /> No Permit Posted Yes No Re-Inspection on or After: <br /> _ }U rl oo r,5 1A,0 Cle r 0 I! 4oblt,.5 ih i oc <br /> inq <br /> a IV is ' n iso r 4rvo," sodol G <br /> u I O rL diIf <br /> OtA 4 s: de a �' S to ff door u d (A re r.,r s v da <br /> S ons G C; f; �cl,r <br /> uShe3 Wa }Cr GV 44 o ,} G r e a F r"C we 0 <br /> 1Ss <br /> rj <br /> �0r }l'r n fn i - u YP h <br /> d S nai A d <br /> Item/Location TemperatureItem/Location Temperature <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> _.._.... — _._...._.._....--..._._.._._.....-- ...—-.._....— ---- ----- <br /> Name: Hand Sink: of Chlorine: ppm Heat: of <br /> Exp.Date: Warewashing Sink: of Ouat.Amm.: ppm Other: of <br /> Received By/Title: <br /> EH Specialist: - Phone: yv /6 Y <br /> Time in: Time Out: ' Page of <br /> EHD 16-24 (2^d pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />