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AQu�" SAN JOAQUIN COUN <br /> )O , ........0 <br /> .OG <br /> 4 ENVIRONMENTAL HEALTH DEPARTMENT <br /> - 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax:(209)464-0138 Web:www.si4ov.or /q ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: {��ifY_AhC j 4 # i-D -17 C Date: I S— <br /> Address: ZCA 0 0 E _ 1 G City: ST Lel Zip Code: �21 <br /> Owner/operator: �,�M� / U Telephone: <br /> Program Eleme I 1 k., L Program�Rlecor Inspection Type: <br /> SB180 Poste Yes No Permit Posted Y s No Re-Inspection on or After: <br /> , C3BSER1{AT{flN1N� RF?ECTa�I ., C3J0t� <br /> "�,- ssr "a T3u^2,n;a e• ,m ;:F,".'m n.. v . .as F.�m��e..rk. :;4-0,-, <br /> -- <br /> _ G1CA11CA4a sfi 3 it cin <br /> —G t k-eUW CA <br /> -- - t- n cin Tht jLi\t Pff`S &ijZ ar �)O'r w )RR <br /> x wcCx <br /> P-OA, � � 01 nofi C10 s''Ae - Ttr") CA cS? <br /> -- -- -.......------------. <br /> '�" U� 1SS1AlZ �Q,�ZJIr�-1' c 2 CAS <br /> Item/Location Temperature Item I Location Temperature <br /> Food Safety CertificationF Facility Hot Water7emperature Warewashing <br /> Name: mG4,G� 1 - -Hand Sink: �� ChPMlorine: n PHeat: F <br /> Ft� L� °F 11ti�+.1 <br /> Exp.Date: , arewashing Sink: i C" 'FOuat.Amm.: ppm Other: eF <br /> Received By/Title: <br /> EH Specialist: Phone: / <br /> Time in: :bo q Time Out: �. ,C/� Page,)of 2 <br /> EHD 16-24 (2^"pg) 4/3/13 V FOOD PROGRAM OIR CONTINUATION <br />