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SAN JOAQUIN COUNT"" <br /> ENVIRONMENTAL HEALTH DEF-rRTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.s*Aov.org/ehd <br /> �IFORt� <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: M C c'I j_S Date: -/-57-/-/ <br /> Address: -2'Y rn,-;i City: 1 Zip Code: <br /> Owner/Operator: 1 _r (D P1 <br /> Q Q ViG 7 ZXiI Telephone: <br /> Program Element: O� ProgramRecord: C,0czt) 35-�;-(5 <br /> GV Inspection Type: <br /> fl ccs G�t <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> �d M a (4S q e_S e -. + c krcArzsAZ_-J <br /> Mcklu Nor- I2 ear o dak k�er' a <br /> o harct <br /> a <br /> a e 4n�i hLv ca n no 6,r cJel'e D�Sei-ve�f, <br /> Uh orf co �� -y ' 4-1 <br /> Pr <br /> V O_Ckf I►1 C­61C c rv,G,r v, cal <br /> I <br /> Item/Location Temperature Item/Location Temperature <br /> c/V� Ito holt Oti - - -- -- -- <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> _ — .— - ------......_..-----...._-._....__.._ - .._ .. - ---._... ---- -- — ----- <br /> Name: Hand Sink: C) of Chlorine: ppm Heat: of <br /> Exp.Date: Warewashing Sink: of Ouat.Amm.: ppm Other: of <br /> Received By/Title: <br /> EH Specialist: 1 Phone: <br /> Time in: ( �`�1— Time Out: / ; Page /of r <br /> EHD 16-24 (2n1 pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />