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SAN JOAOUIN COU, t <br /> N: < <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax: (209) 464-0138 Web:www.sigov.orq/ehd <br /> ��FORa <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: Grl_ n, _ <br /> Address: 22 `' City: Zip Code: q 3 3 <br /> Owner/Operator: C� Ove Telephone: <br /> � 0*3 S <br /> Program Element: Program Reco d: `1 _ Inspection Type: <br /> F5180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> ' OBSERVATIONS AND CORRECTIVE ACTIONS <br /> S C ( �t - <br /> < <br /> 2 - - l <br /> — ' �� l <br /> 1 <br /> 1 <br /> Ite �3 Temperatures Item(Location <br /> Food Sa`,ety Certification FaciNty Net d+z.t'.t Temperature Ii____ — Vl'zrewashing <br /> Name: Hand Sink: F Chlorine: PPM hea: F <br /> Exp.Date: arewashing Sink: —� aF at.Am m.: PPm jOther: of <br /> Received By/Title: <br /> EH Specialist: — Phone: V <br /> Time in: Time Out: Page�pf 2 <br /> EHD 16-24 !21,pgj 4;313 FOOD PROGRAM OR CONTINUATION <br />