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SAN JOAOUIN COUr <br /> N: <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> X <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.s4gov.org/ehd <br /> ��FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: �� M Ml1` j•� Date: p/ <br /> 4 <br /> Address: 1�2� - �l City: ZipCode: <br /> Owner/Operator: 1'� Telephone: _ <br /> 1 <br /> Program Element: (o(7U Program Record: C oQo-127T Inspection Type: Cc R� <br /> SB180 Posted Yes No Permit Posted Yes No Re-inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> cpm Mari 4, r <br /> CA- G k1gh c. -c <br /> Man aw owafzot cmqlain-- <br /> as MO <br /> NNa,,-., Iis loved h " yed A�aAc, uW Ao Vkace <br /> ' Va CAQvqffi11s O w&4?, P,�R h S <br /> \a- was SAnnnIT)CA <br /> Disum)(nUe USi n ine \T)CXC'WI ra -\S <br /> Item/Location Temperature Item 1 Location Temperature <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: of Chlorine: ppm Heat: 'F <br /> Exp.Date: Warewashing Sink: of Quat.Amm.: Ppm Other: of <br /> Received By/Title: <br /> EH Specialist: Phone: <br /> �- - Cwt- oi5- 2)414 (0 <br /> Time in: O, Time Out: `` �G Page of I <br /> EHD 16-24 (2M pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />