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SAN JOAQUIN COU, <br /> .X ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax: (209)464-0138 Web:www.sigov.org/ehd <br /> t/i=pR� <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: /� 4 <br /> Address: p V �/L City: Zip Code: <br /> Owner/Operator: �, G' , Telephone: <br /> Program Element Program Record: Inspection Type: �►� �+ <br /> B180 Posted ❑Yes ❑ Rermit Posted ❑Yes ❑t Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> hrA-,4 ds <br /> uud c,�ieivi . <br /> GWA <br /> 44 V <br /> v\tzti/tiv..%/k- ,A ,qll�d . <br /> oc�e, v <br /> d_A_y_,4 I <br /> I-SAU-A�4a,ti 4- <br /> '�tv►r� titin n���2.ti�„ {,- <br /> 1_ocation Temperature <br /> Food Safety Certification Facility Hot Water Temperature �C Warewashing <br /> Name: - Hand Sink: F Chlorine: ppm Heat _ F <br /> Exp. Date: arewashing Sink: Quat. Arnm.: ppOtl her: 'F <br /> Received By/Title:I" <br /> It C/a r I IA\V f% <br /> EH Specialist: UwkA� Phone: <br /> Time in: Time Out: Paged of <br /> EHD 16-24 (211 pg) 4/3113 B W JI -,1:J.-,1 5�. <br />