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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> c4... ..,..;P Telephone:(209) 468-3420 Fax:(209)464-0138 Web:www.sigov.orq/ehd <br /> �rFoaa <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Gr I ` Date: <br /> Address: 2 (0 City: S-�� - � Zip Code: q0 1 <br /> Owner/Operator: �u h Telephone: Glj <br /> r _l <br /> Program Element: P�ogram Record: �} I Inspection Type: �zwliD_P_ <br /> SB180 Poste Yes No Permit Pos=s.) <br /> e es) No _1 Re-Inspection on or After: w Qe�—' <br /> OBSERVATIONS AND-CORRECTIVE ACTIONS <br /> C 1h cry U <br /> VSA <br /> rtQ - <br /> loo Qf)y-.�, 'IP a dr d"I r un ~fes <br /> 6 THeu (JW/f) C+ c "-Wr _ ice_ m <br /> f e - S On ftc6 CoNam,"5 CAVCAn <br /> MO c4\S CAV if, V1 Ck cft oc ?. CLCQ- <br /> CA <br /> 4,e"\S &q c f <br /> VW 4&W,2 )C 0r T-Ood Rk3 PtScuVtw <br /> Asa ?_-�Jc ll- oy-eb C S 1( t'k . C" Un �Dc c� a <br /> ItenVLocation ,Temperature Item Location Temperature` <br /> Food Safety Certification Facility Hot Water Temperature Warewashing 'Al <br /> Name: C 6� Hand Sink: ��J 'F r <br /> lorine: Ppm Heat: =F <br /> Exp.Date: Warewashing Sink: r /i; of Ouat.Amm.: ppm Other: 'F <br /> Received By/Title: ✓ 1 I V <br /> EH Specialist: Phone: <br /> Time in: :S� Time Out: i U � Page of !7 <br /> END 16-24 (2n1 pg) 4/3113 FOOD PROGRAM OIR CONTINUATION <br />