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og41'"' SAN .1OAQUIN COUN* <br /> '+ ENVIRONMENTAL HEALTH DEPARTMENT <br /> W :< <br /> _ 600 East Main Street, Stockton, CA 95202-3029 <br /> Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.sigov.orq/ehd <br /> �L�FORN <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: <br /> Address: 53 0 G/. C_ City: Zip Code: g5 20 7 <br /> Owner/Operator: //G n 'R 0.2-0,0Telephone:y- BO,0 <br /> Program Element: 1 Program/'Record: 19 14 Inspection Type: <br /> 140 Ro l <br /> S6180 Posted Yes - No Permit Posted _ Yes _ No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> � v - <br /> w <br /> Item/Location Temperature Item/Location Temperature Item/Location Temperature <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: of Chlorine: ppm Heat: of <br /> Exp.Date: rewashi nk: of Quat.Amm.: ppm Other: of <br /> Received By/Title: <br /> EH Specialist: ., fi L Phon _-7 p 7 <br /> Time in: 7 Time Out: I l [ o Pagel of / <br /> EHD 16-24 (2^d pg) 1/16/12 E 'T FOOD PROGRAM OIR CONTINUATION <br />