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SAN JOAQUIN COUNTY <br />' ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />kq.,, ...... p Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sigov.org/ehd <br />CIFORP <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />Name of Facility: 'VL. Nil 197,A� � 4--e4 kilt 41r,, _ _ Date: 172-7 <br />12-73 <br />Address: 33 73 W / City: Zip Code: <br />Owner/Operator: GNB 1Af7T m Telephone: <br />Program Element: �1' Program Record: `j//_ q� Inspection Type: <br />(L� <br />6180 Posted Yes No Permit Posted Yes No Re -Inspection on or After: <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />0 10 ✓Vi L L II6V71V C0 Lid,;I, <br />v <br />tJ,. <br />rib <br />wu <br />C <br />VQ, <br />— <br />rc4e ,�e� -k k 4v "W4 ItF <br />raw um - -iti y4r� — <br />_1V IMA <br />6-tv� I I a VM2 — <br />LI` 1 <br />/� -Maw Iry n <br />�,l 7 1[ <br />W V•���/J/✓ C �� <br />jv <br />Rem/Location �J Temper�re /. Item / Location <br />WWy �Gtk1'W J- UYf h -iL4YjL11 <br />Temperature_ <br />Food Safety Certification Facility Hot water Temperature <br />Name. L 'Hand Sink: of <br />"Warewashing <br />'Chlorine: ppm Heat: <br />'F <br />Exp, Date: arewashing Sink: eF <br />— <br />Ouat. Amm.: ppm Other: <br />- <br />,F <br />Received By/ Title - <br />le -EH <br />Elf Specialist:V <br />` <br />Phone: <br />! . <br />lK <br />Time in:911,0 Time Out: T' <br />Page of <br />EHO 16-24 (2- pg) 413113 FOOD PROGRAM OF CONTINUATION <br />