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PpulK SAN JOAQUIN COUI, <br /> Ila: ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax: (209)464-0138 Web:www.sogov.org/ehd <br /> �/POR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: j Date: <br /> Address: City: Zip Code: Z.1 1 , <br /> ca <br /> Owner/Operator: Telephone: <br /> Program Element: 1(03 Program Record: [� c'3--74 a ( Inspection Type:• <br /> 8180 Posted ❑Yes 0 Rermit Posted 1' ❑Yes ❑i Re-Inspection on or After: <br /> tz f <br /> C400 V Cv C_d oX s a <br /> ' r b • <br /> h ho r - - k 'b r a - 12 j2�a c_o <br /> -e V-e ' <br /> Cya.1k.L411 _j <br /> t5 kA n j�e.r CA Y A nn8 40CI54 rh r Ce r+ ' <br /> b r7fn Vfoo <br /> r �-C <br /> on ci n.> ba n, lShaLA 4=e <br /> bfV <br /> t - Com -�- r r,,-C Lr <br /> O r <br /> /O � 1 [.y e_IC_ z* of 21C <br /> Ung I <br /> = - Temture item t Location Temperature <br /> , t <br /> ------ ---- <br /> Food Safety Certification r Facility Hot Water Temperatures. Warewashing <br /> - f <br /> Name: Hand Sink: of chlorine: ppm �il­leat: of <br /> lJc <br /> Exp. Date: �1Narewashing Sink: 1p of Quat. Amm.: ppm (Other: of <br /> Received By/Title: Jr� <br /> U <br /> EH Specialist: / Phone: 07163- 122 <br /> 7163- 1 '� <br /> Time in: I i`� 6 Time Out: 1 O , ( � Page of. <br /> EHD 16-24 (2n1 pg) 413/13 FOOD PROGRAM OIR CONTINUATION <br />