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4"'" SAN .10AQUIN COUN <br /> Q` ENVIRONMENTAL HEALTH DEPORTMENT <br /> . <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> c.. _ ;P• Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.slgov.org/ehd <br /> . <br /> q�/F o.RN <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: G C]n A Date: �5 _� <br /> Address: 2City: S G/i Zip Code: 05 ZD <br /> Owner/Operator: 1 r- 00/1-+—/\) H ! — Telephone:raxbe S c7"Fo-2- <br /> Program Element: 16 Z,S Progr m Record: U / Inspection Type: <br /> U <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> 1 CA ./- <br /> 1 /A --cw �liA o v ik, �,- �a • �� r -t�r� <br /> tiA':sj �- <br /> 2 e <br /> Item/Location Temperature Item/Location Temperature <br /> Footi,Safety;Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: of Chlorine: ppm Heat: of <br /> Exp.Date: Warewashing Sink: of Ouat.Amm.: ppm Other: of <br /> Received By/Title: <br /> EH Specialist: Phone: (Qb—?yy <br /> Time in: v Time Out: / : Page(of I <br /> EHD 16-24 (2^d pg) 4/3113 FOOD PROGRAM OIR CONTINUATION <br />