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,0 P4 �60 ;E SAN JOAQUIN COI !'Y <br /> :a ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax: (209) 464-0138 Web:www.si oq v.org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility. �,114G,r� x �e - S C{ Date: 1� <br /> Address: ` �� City: �--i tti1 Zip Code: <br /> IVI� • Ic/r _ <br /> Owner/Operator: , `l - - Telephone: <br /> Program Element: l Program Record: 22)CO Inspection Type; <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTI6 <br /> No n i C;1 c ufT on <br /> p <br /> V iS NVnn91 a <br /> c,w - 11 S cc e - <br /> tJ4 #Rflt4e <br /> e 1 PAC iU v��n S awak, <br /> A 04_'5. dr- Mi-1- " 1N- <br /> W-ql _U 1rzS� w�t1 a U <br /> Item/Location Temperature --- m rature <br /> j. Food Safety Certification F7jaia l ty Hat Water Temperature Warewashing <br /> Name: Hand Sink: °F Ghiorine: PPm Heat: ,F <br /> Exp Date: Warewashing Sink: of uat.Amm.: PPm ther: eF <br /> Received By 1 Title: <br /> --- <br /> EH Specialist: Phone: (OS <br /> Time in: k.j Time Out: Page iz <br /> EHD 16-24 (2W pg) 4013 FOOD PROGRAM OIR CONTINUATION <br />