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SAN JOAQUIN CCOLIN <br /> " 2+ ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • �q.; a;P. Telephone: (209) 468-3420 Fax: (209)464-0138 Web:www.sigov.org/ehd <br /> �IFpR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: 77 uv vV G � Date: �3 �s- <br /> ddress: /2 City: Zip Code: <br /> Owner/Operator: 1 e ,/� G/ Q/ Telephone: ,, •y— <br /> Program Element: If 01 Program Record: G SO r Inspection Typed <br /> SS180 Posted Yes ❑ Rermit Posted es ❑1 Re-Inspection on or After: <br /> g <br /> �� _ __. <br /> - OBSERVATIONS AND CORRECTIVE ACTIONS <br /> pa":; , <br /> ") F77C <br /> ItelLocatipitem I Location _. " "Temperature <br /> w�► �F a wtl�" /I.e94 /14PV Akq LLq3F <br /> 4r` 6 _ <br /> Food Safety Certification Facility Hot Water Temperature i Warewashingj� <br /> Name: Hand Sink: j S of IChlorine: Ppm Heat: --I� of <br /> Exp. Date: a , , arewashing Sink: 3 of Quat.Amm.: ppm ther: of <br /> IJ / <br /> Received By/Title: <br /> EH Specialist: Phone: <br /> Time in: `' Time Out: Pagij�4f <br /> EHD 16-24 (2nd pg) 4/3/13 FOOD PROGRAM OR CONTINUATION <br />