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SAN JOAQUIN COUP" <br /> N'. ENVIRONMENTAL HEALTH DEPARTMENT <br /> _ = 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> .,. . Telephone: (209)468-3420 Fax: (209) 464-0138 Web:www.sigov.org/ehd <br /> �i 6 <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: l I S � C 6 . r7/- 1''d r Date: <br /> Y <br /> Address: 1-64 r1a City: Zip Code: <br /> Y l � <br /> Owner/Operator: Telephone: <br /> Program Element: Program Record: Q Inspection Type: t- <br /> Co B180 Posted Posted ❑Yes ❑ Rermit Posted ❑Yes ❑1 Re-Inspection on or After: <br /> } tA4{p tCTNQNS .., <br /> s s <br /> .. �. <br /> Db <br /> SPYI/;['rl�S / o V o -e du C_u C C2a T <br /> v K'P-e_H a�-, : c//C 4 <br /> a of C4 <br /> rr o <br /> L vt Gl c <br /> Item/Location ; Temperature Item/Location Temperature <br /> Food Safety Cert+ficataonFacility Hot Water Temperature 1� Warewashing <br /> Name: Hand Sink: of Chlorine: ppm Heat: of <br /> Exp.Date: Warewashing Sink: of Quat.Amm.: ppm ther: of <br /> Received By/Title: <br /> EH Specialist: /_ - Phone: -) , <br /> Time in: D Time Out: ` Pagel of <br /> EHD 16-24 (211 pg) 4;3113 FOOD PRDGR-IV <br />