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SAN aJOAQUIN COU Y <br /> a ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> �4... .•.�;�P Telephone:(209) 468-3420 Fax:(209)464-0138 Web:www.si4ov.orLe <br /> _ /chd <br /> <<FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: !j CGS tU�,S77 77 u 77 I Date: CU ``5 <br /> Address: �- S CU I I f-cy 1)SCI City: ftc Zip Code: Fjr�`J <br /> Owner/Operator: O W 1� 'n Telephone: ` �rj <br /> Program Element: f 3G, '"` Program Record: 'FIZ W52 Gq 4-'1- Inspection Type YonC,' <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> QBSERVATIaNS'AND CORRECTIVE;ACTICtNS <br /> . <br /> ---._........__................. ..................-- --- --........__....... <br /> _...---................_.. -- -- <br /> Item/Location i Temperature Item I Location Temperature <br /> =— - -- <br /> Food Safety Certification Facility Hot,water Temperature Wareinrashin ; <br /> Name: Hand Sink: �F Chlorine: ppm Heat: -F <br /> Exp.Date: arewashing Sink: of Quat.Amm.: PPM Other: of <br /> Received By/Title: <br /> EH Specialist: Phone: /i I_ d <br /> Time in: Time Out: ��'"tJ� t7 1Pagi of 1 <br /> EHD 16-24 (2^1 pg) 4/3/13 FOOD PROGRAM OR CONTINUATION <br />