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SAN JOAQUIN COU* <br /> y� ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • cQ.• = :a�P• Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.sigov.org/ehd <br /> L/FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: I�c D� U�-�-e # -4-0-3 I Date: �5/ <br /> Address: 22 ! Qn 1.- C L City: �� tiv� Zip Code: <br /> Owner/Operator: GX4 � t (W J\{-O,rf i�� Telephone: � U- <br /> l� M �� J <br /> Program Element: I` ' Program Record: I 1_ I '"� Inspection Type: fi <br /> SB180 Posted Yes No �U Permit Poste es No ICJ Re-Inspection on or After: <br /> , ..r <br /> IPBSERVATIONS AND C�C3RRECTIVE 14CT1ClNS: <br /> c <br /> _ ............................... __.__....__.._._............................_........._....-"—_ <br /> .. ..��...c_..........._w._.0 h ,, r��'o t c��- �r 4�`T. sys+- {� � C)-( _ ----- <br /> Cw . <br /> � _ <br /> U_ b s vt� - U -; - ccu--,,p S,nj ---oy)d ru <br /> U e r\ •� w Q e - _..._- <br /> � F1&CXIntC0n a c C� t= <br /> emperature Item 7 t ocatjon, vim, Temperature <br /> fV o hG Uhi4 n <br /> 1iv.,(' 13IA11't <br /> Mu -sing I -- <br /> w; <br /> cl ' Ver raureh <br /> _ <br /> Name: L, 1 ' Hand Sink: G 'F Chlorine: ppm Heat: -F <br /> F� I <br /> Exp.Date: 1Z arewashing Sink: of Qt. mm.: ��I Ppm Other: of <br /> Received By/Title: <br /> EH Specialist: Phone: G F,3 <br /> Time in: ' -- Time Out: i I Page2of Z <br /> EHD 16.24 (21d pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />