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oP41'�' o SAN JOAQUIN COUN' <br /> X ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax:(209)464-0138 Web:www.sl9ov.org/ehd <br /> L�FORN <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: M�o " L G. 6i'\ r o W( J Date: 3- r,13 <br /> Address: / City: _77Zip Code: s3 6 <br /> Owner/Operator: W Telephone: <br /> Program Element: Program Record: Inspection Type: c <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATIONS.AND CORRECTIVE ACTIONS <br /> ./ ; <br /> COrrec1 4oda . <br /> 7C t Sccc i re r&chine . S 4gre <br /> C1 le aii a h le on 4 a ; n or, Corr el 4A <br /> 3 ! v; G a Q a; o c Ie ! e <br /> S 10ee LJ C, lath i r, ti e b u c lee J. <br /> Cc, ir Pc 4C, C/o <br /> Item/Location Temperature Item/Location Temperature Item!Location Temperature <br /> doer W; 4&r&r <br /> C <br /> Food Safety Certification Facility Hot Water Temperature tiNarewashing <br /> k� rt1 <br /> Name: Hand Sink: t ✓c 'F Chlorine: PPM Heat: of <br /> S c- <br /> Exp.Date: Warewashing Sink: / t of Ouat. Amm.: PPM Other: of <br /> Received By/Title <br /> :• <br /> EH Specialist,!-. Phone: j ILr,�/6 <br /> rAy 47 <br /> Time in: vs Time Out: Page of <br /> EHD 16-24 (2nd pg) 4/9/12 FOOD PROGRAM OIR CONTINUATION <br />