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SAN JOAQUIN COL <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> . •.. P• Telephone: (209) 468-3420 Fax:(209) 464-0138 Web:www.sigov.org/ehd <br /> 4�1r=obi' <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: G !� Date: •� L-U <br /> Address: _ * City: Zip Code: p,5 <br /> 206 <br /> Owner/Operator: Telephone: <br /> i <br /> Program Element: I7 b Program Record: e Z Gt inspection Type: � <br /> P. <br /> 5B180 Posted Yes 1 No Permit Posted Yes No U Re-Inspection on or After: <br /> 085ERV MONS AND CORRECTIVE ACTIONS <br /> n Z_ IV ''F <br /> •— � Gdd ��. <br /> !t ` <br /> 1Lava sLA. w. 3 S <br /> S <br /> CA'jt <br /> r • 1 <br /> 1— <br /> l <br /> (7, �Cr — k ' <br /> tiS <br /> Carp � <br /> �t — <br /> �V <br /> Item/Location Temperature Item/Location Temperature <br /> Food Safety Certif ication Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: F Chlorine: PPM Heat: o f <br /> Exp. Dat Warewashing Sink: 'F dual.Amm.: PPm Other: 'F <br /> Received lay/Title: - <br /> EH Specialist: IV, <br /> , Phone: — <br /> Time in: Time Out: jX/yJ. Page of <br /> EHD 1$•24 (211 pg) 413/13 lV FOOD PROGRAM 00 CONTINUATION <br />