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_ I Y — Yom... <br /> SAN JOAQUIN COUNT <br /> 'ate"cOa <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> ...cqY/Fda?ib.. Telephone: (209) 468-3420 Fax: (209)464-0138 Web:www.sigov.org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Q G ',&nC4 <br /> Date: _+/o/I <br /> Address: 1—+ ,S ul-N1 ur City: Sjzrh.frj-n Zip Code: <br /> Owner/Operator: exr)Qn O r3 , G s Telephone: q _q1-0.SIe6 <br /> Program Element: 1 (0 C)3 Program Record: � 1 I-� Inspection Type: ��'.tu-hon <br /> B180 Posted ❑Yes ❑ Rennit Posted O Yes ❑1 Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> Cg U U 2b, <br /> NuuVcO_C I uns n I2 <br /> 6-I -s Pia-mit- av-_wR e a,F <br /> hcll CUrz.1S UTA Sj 1e <br /> N iU r t' rG rlCe CcA.tn C-200-) <br /> Item/Location Temperature Item 1 Location Temperature <br /> 2- j coo 'IT <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: 1 �i S . vnand Sink: `()0 eF hlorine: NCAA I ppm eat: >F <br /> Exp.Date: l� I A-I arewashing Sink: f7 G of ruat.Amm.: PPM ther: eF <br /> Received By/Title: <br /> 77 K <br /> EH Specialist: Phone: r1-0 —.4(02) Ji <br /> Time in: Time Out:O/,rw,q�� `:J Page of <br /> EHD 1624 (2n0 pg) 0/13 'U FOOD PROGRAM OIR CONTINUATION <br />