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SAN JOAQUIN COUP'' <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> . c... , iP• Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.si4ov.orp/ehd <br /> 9CJFo�e� <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: (`- S Date: <br /> Address: O City: L�d <br /> Zip Code: 0 <br /> Owner/Operator: Cf <br /> Telephone: <br /> Program Element: O O Program Record: C �O 3$ 1 Z Inspection Type: <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> S : To i►S f'!-L c_4oAfn,in 4 i s <br /> ve e� es kAve 6 <br /> QJqa <br /> No <br /> vel.l e d� o ro <br /> 6 60_ce�vc -{-G� r� <br /> Item/Location Temperature Item 1 LO'Gi ron #eniperature <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: JV Phone: Lf r- (-(y ."— <br /> Time in: 1 Z y�� Time Out: / Page/01, <br /> EHD 16-24 (2nd pg) 4/3/13 FOOD PROGRAM 0IR CONTINUATION <br />