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.0 <br /> SAN JOAQUIN COUI <br /> ).•. OG <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> Telephone:(209) 468-3420 Fax:(209)464-0138 Web:www.segov.org/ehd <br /> ��FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: G1 r, , Date: _T11_ 7 ( <br /> Address: I C6S / [�I GI ? 1 I1 n City: 1 r` Zip Code: GS} S <br /> Owner/Operator: v I 1 Telephone: <br /> Program Element: Program Record: Inspection Type: R <br /> SB180 Posted Yes C No Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> W C'1 <br /> 01 on4 ; r1 r9jhI rr % c' +` Cr��cILJ . orrecI + n 2 Weed <br /> ry /1 <br /> ✓; tic �C 4 c1 ,J r C�" -i h ✓ r Q 1 <br /> ►� 2 <br /> �or A? c4 r- rol'►'Ic)de�. <br /> Item/Location Temperature Item/Location Temperature Item/Location Temperature <br /> UJO <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: 'F Chlorine: Ppm Heat: of <br /> Exp.Date: Warewashing Sink: of Quat.Amm.: ppm Other: of <br /> Received By/Title: �� �G' �G•7 N 1 ` <br /> EH Specialist: Phone: I� <br /> Time in: O , Time Out: a Page ofIf / <br /> EHD 16-24 (2nd pg) 11/2/09 FOOD PROGRAM OIR CONTINUATION <br />