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SAN JOAQUIN COUN <br /> �o •c°G <br /> ?a ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • C,q., - �P• Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.sipov.orq/ehd <br /> L�PORa <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: G- ��j -�� Date: <br /> Address: / rn �r Z City: L Zip Code: <br /> Owner/Operator: / / Telephone: <br /> Program Element: lam(t(IJ- <br /> 3 Progr m Record: Q Z Z Inspection Type: <br /> SB180 Posted Yes U No Permit Poste Yes No Re-Inspection on or After: <br /> x <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> �. _ Y � <br /> l leu <br /> VV S <br /> Item/Location Temperature Item!Location Tem era ure <br /> G� lo w 2 4k✓ <br /> ✓ l 1� <br /> Food Safety Certification Facility Hot Water TemperatureWarewashing <br /> Name: t, �� L Hand Sink: o f Chlorine: ppm Heat: <br /> 'F <br /> Exp.Date: �' ) V� arewashing Sink: of uat.Amm.: ppm Other: of <br /> G' <br /> Received By/Title: <br /> EH Specialist: /4 ,vK/ c% Phone: / _ <br /> Time in: G1 r Time Out: (•� Page-71-L <br /> EHD 16-24 (2"c pg) 4/3/13 FOOD PROGRAM DIP CONTINUATION <br />