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SAN JOAQUIN COUP"-'' <br /> 2a ENVIRONMENTAL HEALTH DErARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> . �q.. �P. Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.slgov.org/ehd <br /> �jg <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: u'`'L 7`7 pane 77 Date: j 1-lq/4 <br /> Address: ,yZ 5 CP-lt' c t City: S1VC'V- M Zip Code: glJrlo 11�_ <br /> Owner/Operator: GVW S= IuQr l+'_ 114& Telephone: 0--3t <br /> Program Element: t101 <br /> Program Record: P R U 1 ICI« Inspection Type: CSA 1-1C� <br /> SB180 Posted Aes F- No Permit Posted Yes -1 No Re-Inspection on or After: <br /> udlr <br /> Sc"e di r� nd Jabh(, wcAwQath 3 Wmp and Om <br /> 1,o X U A s tv- `5 Sj Um ed d i fecAi on S�W2 <br /> Site <br /> s, <br /> uxe <br /> Tog na6v }fig d ocA c of n Ocrq <br /> SOrd vkC� 1 S ICAN L3 <br /> >>z <br /> r- Sar <br /> Name: Y-\,kI '„r Cwt r1 Hand Sink: r�i o f Chlorine: ppm Heat: 'F <br /> Exp.Date: 1.Zi C I Warewashing Sink: �ZU of Quat.Amm.: ��(� ppm Other: of <br /> Received By/Title: ` <br /> EH Specialist: Phone: 9-zq- '"T�i (d&--3 4,4 G <br /> Time in: v C�cq I, Time Out: �-:Zs- Page)_ofZ <br /> EHD 16-24 (2n1 pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />