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SAN JOAQUIN COUP <br /> �.•.�hoc <br /> p � ENVIRONMENTAL HEALTH DEPARTMENT <br /> ._- 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax:(209)464-0138 Web:www.si4ov.orq/ehd <br /> �IFORl1 <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: ,—e, h i -I Date: ' _-�y I <br /> Address: �c. 1- _ ,+" City: i=ce Zip Code: <br /> V1 H2O <br /> Owner/Operator: i L4 0 r- ,v Telephone: <br /> rv1- <br /> Program Element: I y Program Rec rd: �1 �I Inspection Type: <br /> B180 Posted es No Permit Posted >d%eS No Re-Inspection on or After: ! <br /> 5 i <br /> TK.- a7v,wr tt,.4 'fi r-c C_'VV\ I*,-. 1C'C (c-ih S <br /> c <br /> ct ---q- 1 2_0 _tc- de, <br /> X. <br /> i►��<-. P7'u v t dst 0. nem s c L.-A,- �r l s '1Z [r c:. 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: <br /> /A 1' /J Phone: C _3 Lr� - <br /> Time in: =1 Time Out: j L7 PageZf Z <br /> EHD 16-24 (2M pg) 4/3/13 Com' FOOD PROGRAM OIR CONTINUATION <br />