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SAN JOAQUIN COL Y <br /> ITF <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 /> ��FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: V-qS - Gas Date: :3/c3/ <br /> Address: -3 1-D \14n�, C) City: %7 r?)r y -, Zip Code: <br /> Owner/Operator: C.�1l(1' N4go'1C/1 C� VVt� Telephone:21_ /If -f_150G! <br /> Program Element: Program Record: Inspection Type: Vt(_.: <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> Thtxoe lon O�- nVAsh' W)CO Jan 2 C rl- <br /> - -me NOW vw reA- 0.004 s tp vM e iT., O 00 Wt a <br /> \1 P%,j CAN rCA (0P 5>,A VfM_l Ut4 p,C:- SCGP Oc' SS\ <br /> V 1-tcAt�uVi 41 <br /> Item/Location Temperature Item!Location Temperature <br /> -— - -._. ._._ ......... ......_ <br /> Food Safety Certification Facg#y Hot Water Temperature Warewashing <br /> Name: Hand Sink: °F Chlorine: ppm Heat: �F <br /> Exp.Date: arewashing Sink: °F Ouat. Amm.: m Other. F <br /> Received By/Title: <br /> rz <br /> EH Specialist: Phone: r]� <br /> Time in: G1 Time Out: '3:3-0 <br /> :3-0 rJ Page )of <br /> EHD 16-24 (2"pg) 4/3/13 )/ vv FOOD PROGRAM OIR CONTINUATION <br />