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Ou�N <br /> SAN JOAQUIN COL 'Y <br /> N: X <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.s'gov.org/ehd <br /> ��FORN <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: ` Date: G <br /> Address: / City: C,` Zip Code: <br /> Owner/Operator: / Lam[ Telephone: <br /> Program Element: / Program Record: [� /) b v Inspection Type: .i71 <br /> SB180 Posted Yes No Permit Poste1KYes No O Re-Inspection on or After:/ U <br /> !/i Z YYu ►��J /�-� Z C Z 7'l Ct?<� Zi 2°� 71 <br /> Item/Location 2 Temperature Item/Location Temperature <br /> ho <br /> z---_ - __ . ... 3&F - <br /> �- a-3 <br /> d.Gvcc� 'i4o-,.e�t q, '13-7 C — <br /> iceaCl�- /i� <br /> ----- ---- — <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name Hand Sink: of Chlorine: ppm Heat: of <br /> Exp.Date: Warewashing Sink: ofuat.Amm.: ppm Other: of <br /> ItY <br /> Received By/Title: J <br /> EH Specialist: Phone: <br /> Time in: 1 Time Out: Page of <br /> EHD 16-24 (2n°pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />