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SAN JOAQUIN CO TY <br /> �o.�•Soa <br /> 4 ENVIRONMENTAL HEALTH DEPARTMENT <br /> N: X <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> ��.._F-yR,..;p Telephone:(209) 468-3420 Fax.(209) 464-0138 Web:www.sigov.org/ehd <br /> / OM <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: ,)17& L,7 - -3Q'l Date: l �� <br /> Address: /1., `l /�l� city: Zip Code: <br /> Owner/Operator: (Y m,r / Telephone: <br /> Program Element: / tel/►" Program Record: G / Inspection Type: G�W�,,,C <br /> SB180 Posted Yes / No Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATlONS'AND CORRECTIVE ACTIONS <br /> Gun ate' a <br /> IA��Q Gt LLi,Vv G <br /> CGL <br /> Wl <br /> WY4c <br /> /J-L 1-C k7 KL# <br /> U __ <br /> L/ <br /> 1_"1wdMtP& __j UP <br /> Ll <br /> w <br /> k�U rIPW ktW <br /> . <br /> ItemJLocation - 'Temperature _.- _ Item/Location -- Terii)seT urs <br /> V� -f- <br /> 44hw kvvAmt46, <br /> 3 <br /> r <br /> - -- -- -- -- — -- <br /> ;_ fsty Certification Facii'ity Hot Water Temperature -,= Warewashing <br /> ---- -- --- r:� <br /> Name: Hand Sink: of Chlorine: PPM Heat: `F <br /> Exp.Date: arewashing Sink: 'F Quat.Amm.: ppm Other: 'F <br /> Received By/Title: <br /> EH Specialist: — Phone: <br /> Time in: I S Time Out.- 1— Page-p <br /> EHD 16-24 (2^ pg) 4/3/13 FOOD PROGRAM OR CONTINUATION <br />