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SAN JOAQUIN COUI.f <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.siaov.oro/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> =YesNo <br /> : —� Date:A I l4 L A/1 4 lD S'/ G,3 �4 /I: / (,a r. City: yC ZipCodeASo: /�' Telephone: t 3t: Program Record: Inspection Type: <br /> Yes No Permit Posted Yes No Re-Inspection on or After: <br /> V'.n ? " G 1 W q <br /> a d� Cot/ n �, les. Correcj 2 <br /> 125. / <br /> 1 ; l -14 Cil o ioc�a <br /> 3 ! hort On f 40 h le, PM ✓ d <br /> r c. -r, j <br /> nac <br /> S;n k' talar roo^n s12- <br /> r4n <br /> GC kj SOOF p g2er JCvJe 4f in nip rs. Corre cj <br /> OM ' f rCs4ra"V 15 4oilej S s <br /> Yr) Pn S n b-O.Nl /ac k's is cC tS <br /> r, rov; / <br /> S QA;E,Zorl. 2co cc <br /> V'Gi r l2-�GLi l f VY5f Goof- <br /> WOW--') <br /> Food Safety Certification 'i"Facility Hot Wate?:; <br /> Name .Hand Sink: �OG/ "Fhlorine: PPM aat: "F <br /> Exp.Date: I - , Wa . <br /> arewashing Sink: lel 'F uAmm.: 260 ppm ther: "F <br /> C1 lu <br /> Received By/Title: <br /> EH Specialist: -M 4 <br /> Phone: / Ir <br /> Time in: 12"Y 7 <br /> Time Out: `-�(j Page of <br /> END 1624 (2m pg) 4/3113 FOOD PROGRAM OIR CONTINUATION <br />