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o.P41'"�.0" SAN JOAQUIN COUI <br /> � <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> _ J. 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209)468-3420 Fax:(209) 464-0138 Web:www.siclov.org/ehd <br /> �IFOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: 9 G+ n / 1 "), 1 Date: � j <br /> Address: 1 (12- 1 1 I h r City: —rf q Zip Code: 7 S 3 <br /> Owner/Operator: J Telephone: <br /> Program Element: Program Record: Inspection Type: <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> - OBSERVATIONS AND CORRECTIVE ACTIONS <br /> la <br /> #U ro r <br /> ke: ; MfY10Qnr re <br /> d G h 01I PU u VN I r1 � 11 P LU a i n-1 <br /> // <br /> k S he I Gr 6 VO oamlobje h ee s <br /> 40 be rem ave d 4 c2 Pr tv yo ti G<f: 4(Z.)4C41 <br /> Item/Location Temperature Item/Location Temperature <br /> - .............. <br /> - - -- <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: of Chlorine: m Heat: of <br /> Exp.Date: Warewashing Sink: �F Ouat.Amm.: ppm Other: of <br /> Received By/Title: <br /> i <br /> EH Specialist: - Phone: <br /> Time in: Time Out: Y / Page of <br /> EHD 16-24 (2^d pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />