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�oP° .qoG SAN JOAQUIN COUK <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.sogov.org/ehd <br /> LIFORI� <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: G me I l,1Ch I (Um Date: I•l�� l`— <br /> Address: ACAUa E ICity: � c* <br /> jun Zip Code: <br /> Owner/Operator: C"" C� 1U` Telephone: Aij`4-V, nc-R6 <br /> Program Element: I�w Program Record: p2 0�� � Inspection Type: L, 1`� <br /> B180 Posted es ❑ Permit Posted es ❑I Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> �1 UAl O fih� � c1iu 511 <br /> kk(AH rYJ Ckt U JP01 n 'k S <br /> Gt -tA-j n" vo 41� u hn <br /> 11-,,+2 V - <br /> 3 ( 1nU i t1 -tct <br /> +r �- . bis A WZ MacbLe <br /> _ I - <br /> -tQ e �. <br /> pq WS fi : u+ orep r <br /> Nr ,((. � <br /> Item/LocationTemt�erature ' Item 1 Location Temperature <br /> N 'P -- <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> : ..r <br /> Name: Hand Sink: L of Chlorine: ppm Heat: of <br /> 1 <br /> Exp.Date: Warewashing Sink: �2/� of Quat.Amm.: ppm 11 Other: of <br /> Received By/Title: - V <br /> EH Specialist: Phone: /) X19 2� <br /> Time in: I � (� 01 Time Out: • I c)-.'t V'` �I Page7f <br /> EHD 16-24 (2nd pg) 413/13 FOOD PROGRAM ORCONTINUATION <br />