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oP4uIM a SAN JOAQUIN Col fY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> �: .. X <br /> _ __ 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • ��..• ��P• Telephone:(209) 468-3420 Fax:(209)464-0138 Web:www.si4ov.orq/ehd <br /> �lFOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: G� (�I ,� L Date: g7 l <br /> Address: _ <br /> _15 ) City: Zip Code: <br /> Owner/Operator: Telephone: <br /> Program Element: Program Record: Inspection Type: CC\1 Vt Iv`�fi� <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: 1 <br /> She 6-F <br /> WpRx or VMex- 1 s <br /> VA aC <br /> Man at za <br /> k kvyk Wr_m i-- a�+er_ 1 A-C <br /> Item/Location Temperature Item/Location Temperature <br /> IKU <br /> - ---- - <br /> r �MTCA-.'_ A IF <br /> Food SafetyCertification IL FacilityHot water <br /> .. ...,�..-. Temperature warewashing , <br /> Name: (Hand Sink: of Chlorine: ppm jHeat: 'F <br /> i <br /> Exp.Date: arewashing Sink: of Quat.Amm.: ppm (Other: of <br /> Received By/Title: <br /> EH Specialist: Phone: <br /> Time in: / Time Out: age of <br /> EHD 16-24 (2n,pg) 4/3/13 V FOOD PROGRAM OIR CONTINUATION <br /> �' �lel34 <br />