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°"'" SAN JOAQUIN COUN1 <br /> ?, ENVIRONMENTAL HEALTH DEPARTMENT <br /> r 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • cq._ .'�;P• Telephone: (209) 468-3420 Fax: (209)464-0138 Web:www.sjgov.org/ehd <br /> ��FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: G��,/61C Date: <br /> Address: i � City: G Zip Code: <br /> Owner/Operator: a, Telephone: <br /> Program Element: Program Record: b V Inspection Type: <br /> SB1_0P o s te d Yes ❑ No Permit Postedy,Yes ❑ No v Re-inspection on or After: <br /> OBSERVATIONS AND COR_ RECTIVE ACTION <br /> ✓1 f�-C (� v <br /> r,C� 441j.,4t ✓ f v !J-U <br /> � G r rt � �✓ <br /> .-�U�r,� f �( <br /> At- <br /> Yqu k,CL -e A <br /> ",91,4A-j <br /> �zT/li <br /> a <br /> dghA <br /> �� yy . <br /> A 7a( <br /> J <br /> 7 <br /> Name: Hand Sink: / -F Chlorine: ppm Heat: 'F <br /> Exp.Date: } /I arewashing Sink: I 1 v -F Quat.Amm.: ppm Other: -F <br /> V �T <br /> Received By/Title:" <br /> EH Specialist: <` w� Phone: /� S <br /> Time in: J Time Out: l•C Pag of <br /> EHD 16-24(20 pg) 413/13 FOOD PROGRAM OIR CONTINUATION <br />