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SAN JOAQUIN COUI <br /> X ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • ...- - iP• Telephone: (209) 468-3420 Fax: (209)464-0138 Web:www.sogov.org/ehd <br /> 9{1FORl� <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: M07-7 2 Date: 2llef' --- <br /> ddress: 2-2-3 E - w L9 )Pa< �V� City: �.}-D CJI�tZ31-' Zip Code: , a <br /> Owner/Operator: Telephone: <br /> Program Element: Program Record: Inspection Type: v,s�t <br /> SB180 Posted ❑Yes ❑ Rermit Posted ❑Yes EI Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> G1�ti 1 .QiC� ��G1J1 fi � 12Q It <br /> 'k Cw e j--o t+tb a tcew Tabkl�K4 <br /> COP(. 1 bot_l <br /> Item/Location Temperature Item/Location Temperature <br /> . ......... <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: of Chlorine: ppm Heat: eF <br /> EX-R.-Date: — .... .__..- ------ <br /> tarewashing Sink: of Quat.Amm.: ppm Other: of <br /> Received By/Title: <br /> EH Specialist: Phone: e)-LIP <br /> _ 0G` <br /> TJ <br /> Timein: i ,F Time Out: �'tU Pagefl <br /> EHD 16-24 (2"pg) 413/13 FOOD PROGRAM OIR CONTINUATION <br />