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SAN JOAQUIN COUN' <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> _= 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.slgov.org/ehd <br /> ��FORN <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: +-Q. QK0 "A, �5 `�V- Date: �^ <br /> Address: 3 2�-�— � L n City: toC.r_ fa Zip Code: Z� <br /> Owner/Operator: Q Telephone: <br /> Program Element: Program Record: ' DZ Inspection Type: <br /> iSB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> ,..N- <br /> WORM <br /> I <br /> 21 i ed C <br /> a ^ b <br /> -f- <br /> a�.►� <br /> pry P <br /> D fi'I-\.ZC w,Q-N'0-e r 1�S . (Iry V LI. <br /> e i d <br /> Z, <br /> 0 Qr c.' <br /> Item/Location Temperature Item/Location Temperature <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: of Chlorine: ppm Heat: of <br /> Exp.Date: Warewashing Sink: of Quat.Amm.: ppm Other: of <br /> Received By/Title: <br /> EH Specialist: Phone: ZY <br /> _ �Y <br /> Time in: I ' Time Out: 2 ;Q — Page3of 3 <br /> EHD 16-24 (21 pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />