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SAN JOAQUIN COUN , _ <br /> X 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 /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: G _1 Date: <br /> 12- v- s <br /> Address: 290c) Z 11 �I City: S3 en S Zip Code: n <br /> Lt/' n c `7 -2050 <br /> Owner/Operator: A r l o 7 ^ Telephone: <br /> Program Element: /t 35 Program Record: 3 y� Inspection Type: DF�L�a �a <br /> B180 Posted CkYes ❑ Rermit Posted Ie-Yes ❑1 Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> A !0< T 4 Y <br /> OCi <br /> 1 Ou a h0lw r! r: 7'es-A}err i nS '01 14 ee <br /> C G n'I P rC <br /> re i r : a <br /> pro V . Xe 9 nq 7 d 611 S e Cc'l a/ 6. 04 or <br /> ven ;cle ir% WrnKS <br /> P r o v: �+ 6 r,ver i n W e e)e,5, <br /> �CAn 110 r cc. k ; n V W //!S. <br /> Or rabeke <br /> Q. � /r✓1 �' F a ✓ -- <br /> 2015. <br /> Item/Location Item/Location Temperature <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: iQ of Chlorine: ppm. Heat. of <br /> Exp.Date: 7 shing Sink: 112 of Quat.Amm.: PPM (Other: of <br /> Received By/Title: <br /> H Specialist: Phone: <br /> Time in: IT / Time Out: n7 -�� Page of <br /> ` <br /> EHD 1624 (20°pg) 4/3113 FOOD PROGRAM OR CONTINUATION <br />