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P4"'" SAN JOAQUIN COUN'i r <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> _ 600 East Main Street, Stockton, CA 95202-3029 <br /> Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.sigov.org/ehd <br /> ��FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: _ M4" Date: I zf�7 <br /> Address: /(n 1 f City: Zip Code: <br /> Owner/Operator: Telephone: Ef/,, <br /> Program Element Program Record � /!_ Inspection Type'N' l <br /> "I ! lY `- <br /> SB180 Posted Yes No Permit Posted \Yes No Re-inspection on or After: Iq )-Of/ <br /> -. OBSERVATIONS AND CORRECTIVE ACTIONS /\ <br /> N t <br /> - t 3S` <br /> (ki <br /> u i v✓�L <br /> le ii � 0� S ` Iv .� <br /> AI V - k L1 b P nO r <br /> •�- kme- <br /> CuXk - <br /> �/ <br /> 114 1v l <br /> wl,J a�uv�c r <br /> C- Y� ✓t c ti I-\- 41 A C Cu 10',- <br /> - awo . <br /> h h ,#1_ Vn V a 'k� ( 4✓ h►'� Ol7ur Gcuur�ct�4 <br /> i 0 I V! <br /> Item/u"ion ,Temperature Item/Location Temperature Item!Location ' Temperature <br /> .._.. -_....— -- - <br /> IVA <br /> 0 ((( vt 1 aVr evh(Actol- <br /> -ho'-A <br /> I=acility 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: f Phone:Time in: " , U . Time Out: Page of <br /> EHD 16-24 (2nd pg) 11/2/09 FOOD PROGRAM OIR CONTINUATION <br />