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�Q. SAN JOAOUIN COI <br /> P • <br /> �•cGG <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax.(209)464-0138 Web:www.sagov.org/ehd <br /> L/FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Mot a ` S en a mem Date: <br /> Address: ZCity: Zip Code: <br /> Owner/Operator: rn n Telephone:4:79_ O <br /> Program Element: t L1 Pr ra Record: $ (Z-0O- / _3k6 Inspection Type: <br /> SB180 Posted Yes No Permit Posted Yes No Y� Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> Lq W_- Y74v- - b k_� _ _rn ate- pow &e r- cryi +lvcar . <br /> _ wx a n d - <br /> 1 ra - - <br /> n14 <br /> v c.�,L <br /> f4to ka �.i h -4- V vz_s <br /> 'un in 6 h I. <br /> rdt+ d-ro G s <br /> Ct r2)a-chez A d rS <br /> 24 <br /> C-00 pie r <br /> ------- ---____--------- <br /> .. -___-- <br /> ttemiLocation Temperature Item/Location Temperature <br /> i <br /> i <br /> - _.. - <br /> I <br /> Food Safety_Certification Facrt'ttY Hot Water Temperature <br /> r Warewashing <br /> Name: Hand Sink: of IChlorine: ppm !Heat: F <br /> -- -- - 4 - <br /> Exp. Date: Warewashing Sink: 'F I 1i <br /> Quat.Amm.: ppm !Other: `F <br /> Received By/Title: <br /> EH Specialist: Phone: <br /> Time in: Time Out: f �; �O Page,of 2 <br /> EHD 16-24 (2n,pg) 4/313 FOOD PROGRAM OIR CONTINUATION <br />