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p4 I" SAN JOAQUIN COUIO <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> �;..•,• -•..;P Telephone:(209) 468-3420 Fax:(209)464-0138 Web:www.sioov.org/ehd <br /> Orr dk�' <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: 0h 0J r waDate: 1 <br /> Address: (02(1 \N ch ,N City: Gt-X*Abn Zip Code: 6206 <br /> Owner/Operator:YJ G Gry,t°J1-1 'YI LLL Telephone: <br /> Q <br /> Program Element: { ��(� Programecord: Q 7 (I Inspection Type: 2CA AiftQ_ <br /> SB18O Posted( Yes No Permit Post Yes No Re-Inspection on or After: 1 wQQ k <br /> OBSERVATIONS AND CORRECTIVE ACTIONS C <br /> MWe I\LYi 0i 0 \Ci �J�2�� q SII \.kWaSStl <br /> 4wc, I Coli-Kcri <br /> wNrex iS a+ (6oT . wrlivsk 1-6 rzo"F. u z'r\ 1 not <br /> 9W n 017 JOOds, 6ti 1s SeTI Slu b R_S <br /> t O n , btsCefi+Va &ZWln ii + \N '1S <br /> 3 Iilckt cwotna SIn 2Q, l-. 100 luli t-- <br /> -1h Uy S <br /> M� Stns :s tQgkt f1 �X r n 1 wC�E.(� <br /> Item/Location Temperature Item/Location Temperature <br /> 1 h <br /> a r jz, cf- fz p <br /> a�Cr 5 ( _ t h�tGlc� er1t'r. _ <br /> IV Ir) <br /> Food Safety.Certification - Facility Hot Water Temperature Warewashing. <br /> Name: Hand Sink: (. 'F Chlorine: ��. t ppm Heat: 'F <br /> Exp.Date: �I L�� Warewashing Sink: L �F Ouat. Amm.: - ppm Other: ,F <br /> Received By/Title: <br /> EH Specialist: Phone: _ ,3 <br /> Time in: I Time Out: t` .C)o Page2of 2 <br /> EHD 16-24(2m pg) 41,T13 1 FOOD PROGRAM OR CONTINUATION <br />