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SAN JOAQUIN COL t <br /> 2r z ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> �q..,... ...;P Telephone: (209) 468-3420 Fax: (209) 464-0138 Web:www.sigov.org/ehd <br /> ��FORN <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: TbCA Date: 22S <br /> Address: 2��(2 U City: SAZ CC Zip Code: <br /> Owner/Operator: `-� M Telephone: <br /> Program Element: '�2 Pr gram Record: Nz I G ,T Inspection Type:sot <br /> n� <br /> SB180 Posted Yes No Permit Posted Ye No `C Re-Inspection on or After: u0 <br /> a: <br /> I o v a +- 20 lnv2 adlu.V" Grp nCfL,!� roaGbj2S <br /> i h CW G,4A+ The, Wz �n _aDd NArL -_UA& a9W C dCAC- CaleS <br /> 11) -C*- Tpa . and t nume4,IIII <br /> -QSi- CUO <br /> * TVc;�t. \?4i11oeed -ti G <br /> CN e. <br /> z - i't&- \j-Ck+e-C a - 1'� 2> CO^ �n i O►'t- �t U r. <br /> P41USt i7, <br /> WThQ1 -dr T�L\Ae iS CAS- u F ,etwv <br /> add �I�S fi� <br /> Tl�q+ s aft- Iti ov C0 <br /> 5 u fi Q�es n 0t U\f e � S <br /> Item/Location T,Temperature Item!Location Temperature <br /> 3 ci we'- ►= <br /> gM1M fist I SU _ <br /> C_t h <br /> Food Safety Certification - I( Facility Hot Water Temperature (� Warewashing <br /> Name: <br /> ]JI-land Sink: 1 GU of Chlorine: ,,I ppm Heat: =F <br /> --- — - . ...... --- ---- --. —. — -- - -- <br /> Exp.Date: Warewashing Sink: I U of Quat.Amm.: ppm Other: of <br /> Received By!Title: <br /> Gw <br /> EH Specialist: Phone: <br /> time in: Time Out: ^ Pag!2of <br /> EHD 16-24 (2ntl pg) 41113 FOOD PROGRAM OIR CONTINUATION <br />