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• SAN JOAQUIN COUA <br /> r. ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> Telephone:(209) 468-3420 Fax:(209)464-0138 Web:www.sioov.org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: G r.I1 Date: Tsw <br /> Address: 1120 w I I S u; a c I City: f q Zip Code: CI SJ 76 <br /> Owner/Operator: 0 n- S X03 d.nl/ Telephone: S' 6000 <br /> Program Element: 16 0 Program Reco d: 0 Inspection Type: <br /> 6180 Posted []Yes No Permit Posted 0 Yes ❑No Re-Inspection on or After: <br /> 7 OBSERVATIONS AND CORRECTIVE ACTIONS <br /> V <br /> � 2 <br /> G2 se*45 <br /> O. K . <br /> ReII 4o etro; F ( Once <br /> 'rur U G G / / 1 r <br /> Item/Location Temperature_ Item/jLocation , .,,.. Temperature Item Locatio Temperature. <br /> Wp t <br /> earn ) ti hl ( I 2- dor fe 37r <br /> Food Safety Certification Facility Hot Water Temperature <br /> Name: ,E kA I A) . 0 Sci Ae he Z Hand Sink: aF Chlorine: PPM Heat: !7'FExp.Date: 2, arewashing Sink: of Met.Amm.: PPm ther: <br /> Received By/Title;_ <br /> EH Specialist: ne: <br /> Time in: _ y Time Out: b 0 F9 Page/ of <br /> EHD 1624 (20°pg) 112/09 FOOD PROGRAM OIR CONTINUATION <br /> tcf/Y- 53Y� 8'ogS <br /> /alln . �✓/u�y <br />