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, P0. coo SAN JOAOUIN COUN <br /> Z� ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.sigov.org/ehd <br /> �IFOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: �G M �, N� Date: /1V 14 <br /> Address: \44 <br /> 4L Q City: S� � Zip Code: �_�2_0 <br /> Owner/Operator: FT h G %C., Telephone: qac <br /> Program Element: rl Program Record: �7p�G�L'?�6 2 Inspection Type: NZQ "I <br /> SB180 Posted Yeso Permit Posted Yes No Re Inspection on or After. <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> T61AL 'l(A �etAn(-;. , nrea i_f-, i)IOr WOO SAa1M tCO&' 3� - 16 - <br /> �n c 06(" C)r \41 (N' 36 _SGn;ti m <br /> -3 6 Iv pt" r Line : S t -3 drW,n 1 Atc"_ <br /> MC�01 -- 40101 : 1-�,, "F -1KGF <br /> ISIS -c (.u v nS 10 qct, fiM ho& Glu (.IQUn �sl <br /> Sh C. L) Of- vf& Mol" 0-, (At 4-6 f gno The, L^QLP- 1 S <br /> (�VM save u at � J""7- a�_ fbda Ord <br /> (Of4C )rOZ G \N0fkC-_Mq Cwcaf <br /> W s.a (—U c UIQ cr '�LCAm Q I S Cat <br /> 1A-Jon'(S vycfe cut CM CUCAPx 1-hun -kmr <br /> bf 1`+:- cA �e low . )Lt Wa S OCkVd tO S U n-W r0 c I m'r, l(1124S <br /> Meld -\m Ori ctfmwF k urs-rnQcLtf-\- 3 � <br /> CAWn A-zda� , - <br /> 1-a " <br /> 'Oor goy - nc+- 3-can? 120'T U <br /> N 0 Vi 6CA+tc.qS ' I <br /> %bel `NtG na `S , a W cb S� Rw i q 2 W ee 1� s <br /> C G4ed <br /> -i <br /> (),kQ, ^c /2 C,kiC'r-\ i t i f <br /> 1temlLocation Temperature , v` ;> Temperature <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> — ------- — Ch-- -- ---- <br /> Name: Hand Sink: of lorine: PPM Heat: of <br /> Exp.Date: Warewashing Sink: of Quat.Amm.: PPM Other: of <br /> Received By/Title. ' 5 . 1—u t-A Pk L lJ , Zi✓�� (j`l �( (-A C.► <br /> EH Specialist: Phone: ZC q _ �t,1 4- <br /> fO <br /> Time in: Time Out: Page;. Df .i <br /> EHD 16-24 (2nd pg) 4/3/13 FOOD PROGRAM DIP CONTINUATION <br />