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SAN JOAQUIN COUI`' <br /> N: X <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> --__ 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> cq.. ip Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.sogov.org/ehd <br /> �/FORa <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: l = Date: 9 _ 3— <br /> C� �C\ � C" '1 <br /> Address: —� rJy City: Zip Code: <br /> Owner/Operator: ` a �� ���S� Telephone: 'ZS <br /> _ Gk SS__7 <br /> Program Element: Z Prograffi Record: c� Q Inspection Type:C <br /> SB180 Posted Yes No Permit Posted Yes No V Re-Inspection on or After: OF <br /> 77 3 --1 b F <br /> M S c�: <br /> 2 r <br /> 2 �Gt <br /> l IA 1 c3� <br /> b 2 <br /> 'r 2C b <br /> t 2 `i <br /> Item/Location Temperature Item/Location Temperature <br /> v.:! e- H\ C J t1 0= <br /> `-1 >9 F- <br /> `��� <br /> - od Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: e \ Hand Sink: ;C)C1 'F Chlorine: ppm Heat: F <br /> Exp. Date: C7 arewashing Sink: `.L o f Quat.Amm.: ppm Other: 'F <br /> Received By/Title: <br /> EH Specialist: Phone: <br /> Time in: rQ ' S c Time Out: C• J Page of <br /> EHD 16-24 (2^d pg) 4/3/13 J FOOD PROGRAM OIR CONTINUATION <br />