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�PGL"`"' �G SAN .10AQUIN C 9F� <br /> ).• '•.O <br /> N: ; :< <br /> ENVIRONMENTAL HEALTH DEP <br /> HWENT <br /> .'•. _ = 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.sjgov.org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: ) t �C, -�TC A 7,4 Date: f� <br /> Address: 24 I Ifl vQ U City: r y�_�� Zip Code: r iu <br /> Owner/Operator: JGA _ _ 1 a 1, �l V Telephone: -f�-_C,l� <br /> Program Element: C.T 1 Program Record: p �� T� l� (C/D,4542 Inspection Type: 1J 11 <br /> SB180 Posted Yes No l/ Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> or U c e wi Rx,e6 -1-�r w a 2 - <br /> c� \S C\\'�,d C ID (,��U U <br /> 'Qx14 ACU\Nou<Y-t� .IfAM6 &QXV Un CAn,�n� <br /> b coOim -ru k s> Un G c�C4t� <br /> i('U , r Gt e- L h ucd <br /> aft CA , <br /> 3 \1 1S. 1 GI <br /> 11 Cn' Ste. 1?- Zt1 C, -LJL vr1 1 �cds r <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: 'F Chlorine: ppm Heat: `F <br /> Exp.Date: Warewashing Sink: of Ouat.Amm.: ppm IOther: 'F <br /> Received By/Title: J <br /> EH Specialist: Phone: r _Vf0 4 <br /> Time in:\ j-i� Time Out: � , rJ I Page of i <br /> EHD 16-24 (2o°pg) 4/3113 FOOD PROGRAM OIR CONTINUATION <br />