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SAN aJOAQUIN COUN <br /> 4 Za ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> �;.... •.�;;P Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.sigov.orq/ehd <br /> L�FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: 61,C 5 I r v I G Z4; Date: I Z I /L/ <br /> Address: , S O (� 5. a r I L' r1 (� City: a a h r c Zip Code: S s s G <br /> Owner/Operator: Telephone: <br /> Program Element: Program Record: Inspection Type: G J4 C <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> f <br /> pry 1in� re �r ; gf-a4cr;� has bf ddn 9u4Kr....._ S-�--- <br /> R....-..._....... _ _ _ _ _ <br /> cis <br /> Cl i S a r e%S e 6q=; I <br /> all V ov d r "C l5 C' 4;'C' -f laor <br /> G r re c l t o t/A Cdrric tc G/• <br /> y0 C, IV -.1n 10CWS I' f - 0 ✓er-> roy; r,/e 4o da <br /> }err on / �j f n <br /> : C Ke., . .1 S romplillAn A �_ / � 0 1� N / . I✓ ` Sr . r �C,� <br /> P I U Or a b ove I3S <br /> o d a h a Z Z IPS ..a Ve. b tl ; I d- u �- _G l k n 4 c <br /> Gt h -; rN n <br /> �(,f � i s ec 4;on r P <br /> � <br /> Item/Location �i Temperature - item/Location -Temperature <br /> V �a► blz- c' yU <br /> rt12 �Ghfe uI F S409M lab/ %6 C! <br /> : lSre•' 13s !� <br /> Food Safety Certification `Fac ility Hot Water Temperature Warewashing <br /> Name: Hrn Hand Sink: 'F Chlorine: Ppm ;Heat: F <br /> h v r� <br /> Exp.Date: arewashing Sink: i of Quat.Amm.: PPM Other: of <br /> t <br /> Received By/Title: <br /> EH Specialist: Phone: <br /> _- 6w <br /> Time in: Time Out: 3 Page2of <br /> EHD 16-24 (2^ pg) 413+13 FOOD PROGRAM OIR CONTINUATION <br />