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PQ"I" SAN JOAOUIN COUP <br /> y+ ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • ... ;P• Telephone: (209) 468-3420 Fax: (209) 464-0138 Web:www.slgov.orq/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: K G / "q V4 Date: <br /> Address: �2 r_ fry City: Zip Code: <br /> Owner/Operator: / G w �� Telephone: 3_jr 3 <br /> Program Element: Program Record: �) f�,L Inspection Type: ,,, D <br /> SB180 Posted Yes 1 No Permit Posted Yes(/[-] No Re-Inspection on or After: `i <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> a rd ✓Lv(A'P <br /> Item/Location Temperature Item/Location Temperature <br /> 1 42 CG�tvi11 161 <br /> 6al'vIAc V- I� I <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: 11,(1 e; kHand Sink: �„ -F Chlorine: ppm Heat: of <br /> Exp.Date: L� ,! rewashing Sink: ( � �F Quat.Amm.: ppm Other: of <br /> Received By/Titl <br /> EH Specialist: / r Phone: -�r— ,Fes-t <br /> Time in: ITime Out: Page of <br /> EHD 16-24 (2nd Pg) 4/3/13 FOOD PROGRAM OR CONTINUATION <br />