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SAN JOAQUIN COUNT`S <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> . ... - �p• Telephone: (209) 468-3420 Fax:(209) 464-0138 Web:www.sigov.orp/ehd <br /> q�'FOR� <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: C' Date:4 12 }) CG <br /> Address: ' G h City: S-� � Zip Code: �G2 <br /> Owner/Operator: e-, Telephone: /,� <br /> Program Element: ,I,0(,—,> Program Record: W,G I B G G,C� �' S� oU T"binspection Type: C`TM� �u`\���J-j <br /> SB180 Posted Yes No Permit Posted Yes No U Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> 1 S 5 PVN UN VWAS)r 1 \ CSI <br /> 1n The � <br /> ('N f'4- 11 S w S fiv11 rrr 1u u _ <br /> �- C/O n L eo k <br /> i ho�r� r✓1�.� �r s - .e G 11 66 }mac <br /> ao �QG nem <br /> ar k" D •S -i f C n c+ <br /> )Prrvi� � <br /> 4:1 = ��2 - <br /> FoOO 1b <br /> Item/Location . Temperature Item I Location Temperature <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> _ <br /> _....... ------ ---- ----.... — — -- <br /> Name: Hand Sink: JO 'F Chlorine: v� ppm Heat: of <br /> Exp.Date: Warewashing Sink: 110 of Quat.Amm.: ppm Other: of <br /> Received By/Title: �7k U <br /> EH Specialist: J - Phone: <br /> Time in: '0 Time Out: t 1 . ty Page �f <br /> EHD 16-24 (2°pg) 4/3/13 1 FOOD PROGRAM OIR CONTINUATION <br />