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oPQ�I" SAN JOAQUIN COUP' <br /> Q` 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 /> �l FORN <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: l' -C �. Date: /'� <br /> Address: City: yhaZip Code: <br /> Owner/Operator: r� Telephone: <br /> Program Element: Program Record: 5-2 Inspection Type: r <br /> SB180 Posted Yes No Permit Poste Yes No Re-Inspection on or After: <br /> G <br /> �'l 61P1qnV&UG v &I V61- vL i <br /> C <br /> qWW <br /> Ila, 144 .44 b24 <br /> \ ♦ - ✓ v( <br /> 00 err Cly � <br /> VI 1► ^P/p timet Cr? — <br /> rou - S <br /> C- <br /> of w �(Q <br /> IrWV <br /> `►M1 ' 04 10, laki - s <br /> C 4r1k'_ <br /> AeaC _, kit AIW - 3 l - <br /> ItemlLocation Temperature Item l Location Temperature <br /> _. ------ ---- -- —..._ .._..-- -- - -,.. - --- <br /> �y= -- - <br /> -tr Wk r 1�- K <br /> Jt CtO�rn�h� l�Lla y <br /> TTi'17�r('G`f'� n'.r CPIA he <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> [Exp. <br /> ame: , d Hand Sink: � 'F Chlorine: ppm Heat: 'F <br /> Date: Wargwashing ink: 1 r; of Ouat.Amm �,l; _3,-�ppm Other: 'F <br /> Received By/Title: <br /> EH Specialist: Phone: /.. <br /> f-1- <br /> Time in: / ; C Time Out: (I� Page of <br /> EHD 16-24 (2nd pg) 4/3/13 J FOOD PROGRAM OIR CONTINUATION <br />