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SAN JOAQUIN COU Y <br /> y., ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • .. :P• Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.s'- ov.orq/ehd <br /> 4�1Foa� <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: 1 vm Glt-g t orld gU Date: I)/'I <br /> Address: Z�(i 5 . �t jpCyMo S-1 cit S�L v� Zip Code: 1�_?`U� <br /> Owner/Operator: M 1t (ADO wtL1' o Telephone: <br /> Program Element: , 1 CI Program Record: P 1 b O f_ Inspection Type: >P-w+ ne <br /> SB180 Posted Yes No Permit Posted Y Yes No 1� Re-Inspection on or After <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> Sc,Q b r� a w',\n i v e K. <br /> hL2S C r w fj U I Q rS Cf4 0A 1�ihIQS <br /> M ulr� i►n �Q �e� -FaCA I h <br /> 3 I I sln cur 11 ND -C sCk 06djQ,0 RX4"- <br /> seCtt .e �O VYJ 0nk <br /> 1n6 0 '\0 Ie , <br /> Q �2 "(Y+ j \J ce \ R11�(I I j <br /> 5 CI�II�s (Jj"1 �fe �AY� rU w + Qtr-j&te. C W h n)Ted l� <br /> brA�Y T(201 C A�P C 5, he Cover SIo X v44A1V ` n Cao - - <br /> cwQf- )11 fVDJS c v . <br /> (-'-,OA- \,VY( n C ^' NS \ed)inC - F1' irN 3 -,toe -S, - <br /> ke f' t GT C G1nir � Tit nes? +a fie <br /> Ur <br /> Item/Location Temperature item/Location Temperature <br /> tt� <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: ( S S�1�f I U Hand Sink: )t. of Chlorine: ppm Heat: of <br /> Exp.Date: � ,� Warewashing Sink: '? L of Quat.Amm.: ppm Other: of <br /> Received By/Title: ` <br /> EH Specialist: Phone: <br /> Time in: 1 : 1 Time Out: "f Page-of z, <br /> EHD 16-24 (2n1 pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />