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SAN JOAQUIN COU' <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.si4ov.orq/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: G1 ` Date: T <br /> Address: -�Z City: Z l,1 Zip Code: <br /> Owner/Operator: Telephone: <br /> Program Element: l Program Record: ) (j Inspection Typ <br /> SB180 Posted Yes No Permit Posted Yes No / Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> I�Gf C L' n -f � L-'/ �'r��7c h <br /> Leh Yll <br /> i �u ✓ - IC W 'r'Q fjU�� <br /> VVC (� 't A- V i I I 11 -ICM&IA 4.1 <br /> 6 to Gf <br /> ' S-k/ ,0 4,L h <br /> J 04 , h a f <br /> r' ' P <br /> ✓1 U000", <br /> ✓ d <br /> v. W ; r <br /> i'uh Vt S I r v►f'v <br /> Item/Location i Temperature item/Location Temperature <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: 'F Chlorine: ppm Heat: of <br /> Exp.Date: arewashing Sink: `F Quat.Amm.: ppm Other: of <br /> Received By/Title: / Q.00 <br /> / (1� / <br /> x C:-. <br /> EH Specialist: Phone: -� <br /> Time in: / r Time Out: t Page of <br /> EHD 16-24 (20°pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />