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SAN JOAQUIN COL 'Y <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> .. p Telephone:(209)468-3420 Fax.(209)464-0138 Web:www.sigov.org/ehd <br /> q�/FO'Ra, <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility <br /> i/h v � a� � G.+.® r� Date: _ D� <br /> Address: 1bQra Ab City) Zip Code: ,6 V <br /> Owner/Operator: F� Telephone• <br /> 1 koL As r•► 408)38 2-7687 <br /> Program Element: 6� /Q (Program Record: 6—� Inspection Type: COtlgu 1 <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> in 1A0 0 d 5 u r{=+o�c� � v�e �c� l� r-eu n--tv y <br /> - Jott.4X , <br /> I;; j UZ r <br /> W�+Iq <br /> LA n o,me l <br /> 00101-s Y-'P— 0 n S A Ali r +Mt l CA-A-A <br /> t44S I <br /> Re rn o y'e- ,o m n 5 -G:4 r1 Q U C-0 V4, <br /> Lj <br /> -1L ' 6s u r rr..:+ On Le_ e_-s. a.e <br /> 19-*,tu rrI +� 'c,c- 40 d Col <br /> '?r o rr► <br /> Item/Location Temperature�� Item/Location i Temperature <br /> s ►,� i <br /> Food Safety Certification Facility Hot that etnperature Warewashtng <br /> Name: L41_ r a n 1!a O r% Hand Sink: /2 a F Chlorine: ppm Heat: <br /> F 1F� !1 _ F <br /> Exp.Date: arewashing Sink: // <br /> i cl;L °F Puat.Amm.4L o�0 ppm Other. of <br /> Received By/Title: <br /> EH Specialist: O AJL ��I., 1/)ChAy k Phone: 1 <br /> Time in: Time Out: Page( of / <br /> EHD 16-24 (2° pg) 4/3/13 FOOD PROGRAM OR CONTINUATION <br />