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,v.RA�' •rA SAN JOAQUIN COLh4Y <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> d4`f dwNa.. Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.sigov.org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: N6 G U Date: 12 , 2- 11 <br /> / <br /> Address: i UI t_ 5'r City: zipcode: 953 ;'4 <br /> Owner/Operator: S G TV)` Telephone: TU.24 (J <br /> Program Element: I I Pr rem Record: S 0613►3 Inspection Type: i <br /> Y c G <br /> B180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: I f Q <br /> ASI 1 4 :0f%S r10 rylic led v,e e 0if <br /> eI; <br /> 04 } a -4 a corree4cal- <br /> zo, <br /> Fi r br.ul� n u � Cir OMA -com �'►o� <br /> 2 Weal <br /> ea✓r <br /> 3 One hood 1: k f. ► R u,I /Lsh <br /> Wee ►` <br /> N I / <br /> (�QII �' ' e ooccrO1CP 61V6 rYQp ,r n 2 weorKS <br /> JOM bF <br /> Per W ell has u Li44,; I.t/:4h S4an .4; 5 Vj a40r. s +•.,. 3 <br /> � orrec4e01. <br /> 5 horn <br /> ; s IAt have fee lei1 - N R rr+ove is <br /> � t'►'1MeA:q 4 ► <br /> ILPr <br /> ; Ii r S rc+ dr IPSSTan ISO a+r1 F. CGr r♦ 1CO. <br /> 1' II u1 r' 0_t n Wert k JPach'A 1 OI 4he 4e <br /> �t IAAF S{A i )iZ Un ) _ _ Cc rrec led. <br /> sA r•S -2-VIVA', Q V"V /- SSC/ Vc A <br /> _1 Temperature Item Location <br /> _.Temper <br /> Food Safety Certification '' facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: .F Chlorine: PPM iHeat: eF <br /> Exp.Date: Warewashing Sink: of Ouat. An-M.: pPm Other: -F <br /> Received By/Tit : <br /> EH Speclallst: Phone: / <br /> Time in: , 0� Time Out: U 6 C Aoof, <br /> EHO 1624 (2m pg)4/313 FOOD PROGRAM OIR CONTINUATION <br />