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SAN JOAQUIN COUN' <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.slgov.org/ehd <br /> ��FORiN <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: 61G Y � �,� Date: <br /> Address: 1,f 71'r'iHtV City: Zip Code: <br /> Owner/Operator: r ele , �j �(O/ l,C Telephone: '7 <br /> Program Element: �- Program/Record: !1 /i3 r Z Inspection Type: ( y, p <br /> SB180 Posted Yes No Permit Posted es No J Re-Inspection on or After: ' "� <br /> 0 Cee g Yv C fr .-tCv� <br /> yk W <br /> k <br /> C' `v <br /> va�take 47 n <br /> W n '�, a Rh vrr�c/h st ,vim <br /> Item/Location 1 Temperature Item/Location Temperature <br /> h 13' <br /> `7 --e l r -X11 37 <br /> d ✓K-/ V, l h-v� <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: 11 �� ,l - Hand Sink: 2 of Chlorine: ppm Heat: 'F <br /> Exp.Date:�•Yl��y arewashing Sink: ) of Ouat.Amm.: ppm Other: of <br /> Received By/Title:k <br /> EH Specialist: Phone: <br /> Time in: t Time Out: 1 Sfl / Page?_01 Z <br /> EHD 16-24 (211 pg) 4/3/13 (/ FOOD PROGRAM OIR CONTINUATION <br />