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oP°"'" F SAN .10AQUIN COUN r <br /> ):' •.OG <br /> `a ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209)468-3420 Fax: (209) 464-0138 Web:www.smgov.org/ehd <br /> ��FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: -..I GC Date: H_lq _ <br /> Address: Pa C. f AVS City: -Pyr) Zip Code: 2 <br /> 5150 2 ,5 .0-7 <br /> Owner/Operator: I O-5 T1'G 4e r Y-Qses 95&- L -3q Telephone: Q <br /> Program Element: 160 1 3 Program Record: n R o 2 9L+ Inspection Type: 1�L)-f rLe' <br /> SB180 Posted)<Yes ❑ No Permit Posted XYes ❑ No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> in 1 to wash u-Ae"s /s <br /> a a -k- n <br /> O ci4awr <br /> v " <br /> rt - 1 <br /> Item/Location Temperature Item/Location Temperature Item 1 Location Temperature <br /> fzo 'o <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: ! of Chlrine:. ppm Heat: of <br /> Ca-t2Ce <br /> Exp. Date: _a-� , arew i g Sink: �� of Quat.Amm.: ppm Other: of <br /> Received By/Title: <br /> EH Specialist: q ,"/_ _ 4C4 -_/_ Phone: 9.5 <br /> Time in: O (���► KFC_ Z•�+ Time Out: , Page <br /> D 15-24 (2nd pg) 4/9/12 FOOD PROGRAM OIR CONTINUATION <br />