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4 <br /> SAN JOAQUIN COO �(N <br /> �O. .0 G <br /> q a ENVIRONMENTAL HEALTH DEPARTMENT <br /> _ = 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax: (209)464-0138 Web:www.sigov.org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: G r _ Date: <br /> Address- l City: J Zip Code: r <br /> OwnerlOperator; Telephone: <br /> 607L <br /> Program Element: Program Record: A <br /> lnsp,6ction Type: �? <br /> r <br /> SB180 Posted ❑Yes D No Permit Posted ❑Yes 0 No Re-Inspection on or After: <br /> OBSERVATI ND CORRECTIVE ACTIONS <br /> -` 1 16 1 <br /> t � <br /> S CJ L C <br /> ,tljk_ ? Z'0/Zc <br /> l �_ <br /> A �C c` ^tilt;���f2.� M 4. .t�2 ` -XZ / e <br /> 140 1 <br /> A'r IPt <br /> L. M G1. tom/ <br /> � ti- C&W� <br /> ry J <br /> ItemlLocation Temperature Item/Location Temperature Item 1 Location Temperature <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: jLl�r of Ghlorine: �� ppm Heat: of <br /> Exp.Date: Fewashing Sink: _f of Quat.Amm.: ppm Other: of <br /> Received By/Title: �^ <br /> EH Specialist: Phone D�3 <br /> K <br /> Time in; Time O t; /�E^ Page of <br /> EHD 16-24(2n1 pg) 4/9112 FOOD PROGRAM OIR CONTINUATION <br />