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oPQ"I" SAN JOAQUIN COUP'! ' <br /> '{ 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 /> L�FORa <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: G Date: V I l <br /> ddress: City: Zip Code: <br /> Owner/Operator: Telephone: <br /> Program Element: 1 Program Record: 2 O� Inspection Type:Lj V V <br /> B180 Posted ❑Yes Ygermit Posted s ❑I Re-inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> gA <br /> L <br /> NA t�kU A4 <br /> v� <br /> ✓�Df.v�Gt <br /> w✓,�"h W A <br /> I Ail <br /> ✓u'F-Q vc <br /> -2C� �, lC� t yak <br /> /J- _ <br /> ItemiLocation <br /> j p � Item!I-oration Temp <br /> Tem e,at�re . �.,,:' a� <br /> Food Safe#y Certitication Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: of �Chlorine: ppm Heat: of <br /> Exp.Date: arewashing Sink: A It uat.Amm.: ppm Other: of <br /> Received By/Title: <br /> ,'/\' C'�) 0,4- I-IQLr <br /> EH Specialist: Phone: <br /> fflAta65 — -... --- <br /> ime in: Time Out: PageO)f <br /> i <br /> EHD 16-24(2"tl pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />