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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web:www.slgov.org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: i1�S C1 t N L'�(3 U� v( `� ati Mcj`2Cj Date: <br /> Address: 2 s City: S.tpivN Zip Code: <br /> Owner/Operator: G V"O-S M 0Telephone: <br /> Program Element: to C, Program Record: CU O d199- 2 Inspection Type: cc I)A 61 a <br /> SB180 Posted ❑Yes 11Rermit Posted ❑Yes ❑1 V Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> Cwt luin�- Str.�Ps : �M ecS SmcY-�nu Ord CA"nkinq ckub ol <br /> n.e.a r tcod T�zu u y- <br /> - bwtitf SAZA�es fih"-e Qre- N 2 P\ wWD <br /> r►o Ts Ul�o i n C'm Dur <br /> _ 111R, 1-�zu c rC>mmj C;am coaq(, I k <br /> t-"kwaes wahfi fio st tom cents av_ E- <br /> TR-v� <br /> em/Locationvy Temperature Item 1 Lacatian Temperature <br /> Food.Safety Certification Facility Hot Water Te..m. perature Warewashing <br /> d _ _. <br /> Name: Hand Sink: of Chlorine: ppm (Heat: of <br /> Exp.Date: Warewashing Sink: of Quat.Amm.: ppm IiOther: of <br /> Received By/Title: <br /> EH Specialist: Phone: <br /> ime in: : I LI I Time Out: - Page(Of <br /> f <br /> EHD 16-24 (2nd pg) 413/13 FOOD PROGRAM OR CONTINUATION <br />