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"""I" SAN JOAQUIN COUP <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> c..• :P Telephone:(209)468-3420 Fax: (209) 464-0138 Web:www.sigov.orq/ehd <br /> 4CjFo�c� <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: �►, r ; G" Date: <br /> Address: /J n r City: G �� Zip Code: <br /> Owner/Operator: v iM ,*ll v Telephone: <br /> Program Element: //i p, !G(Program Record: /� Inspection Type: <br /> !SB180 Posted Yes ❑ No V Permit Posted Yes i No Re-Inspection on or After: <br /> fl6siAVA f 1 5 ► ID CORR <br /> ECT <br /> CTI© <br /> - ��.Vol' <br /> k dt / yr <br /> .P a M ✓ n s a /y�wu�•t t vt,� <br /> of n -1- h <br /> - S <br /> YIl � <br /> f act 4 ` • �(.� ! o� <br /> I GLV�� oc.G /1 f <br /> IIV- <br /> a <br /> 1 ` <br /> 1r,- ' 1-5'C- <br /> 5;0 <br /> S 5;D C <br /> f <br /> � - I <br /> It Temperature Item/Location Temperature <br /> L v_ <br /> ✓ "u fn �.� 944t4 I <br /> Food Safety Certification Facility Hot Water Temperature <br /> F e Warewashing <br /> Name: Hand Sink: of Chlorine: Ppm 11 Heat: of <br /> on <br /> Exp. Date: Warewashing Sink: of Quat.Amm.: PPM Other: of <br /> Received By/Titl <br /> EH Specialist: Phone: <br /> Time in: V V Time Out: Page of/ <br /> EHD 16-24 (2°a pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />