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2 t <br /> SAN J O A Q U I N Environmental Health Department <br /> �1 — C-CUN 1 Y <br /> opt ° Greatness grows here. <br /> Food Program Service Request Inspection Report <br /> Facility Name and Address: NIGHTINGALE COFFEE AND TEA, 1505 MOFFAT BLVD, MANTECA <br /> OBSERVATIONS <br /> Name on Food Safety Certificate: needed Expiration Date: <br /> Warewash Chlorine(Cl): ppm Heat: °F Water/Hot Water Ware Sink Temp: 112°F <br /> Quaternary Ammonia(QA): ppm Hand Sink Temp: 108°F <br /> FOOD ITEM—LOCATION--TEMP°F—COMMENTS <br /> hand sinks—men and women restrooms—100.00°F 1 dr True—33.00°F <br /> NOTES <br /> New owner of coffee shop inside of Crossroads Church. <br /> Facility will only be open Thursday 6pm-7:30pm and Sunday 7:45am-12pm. <br /> Owner to return to 1868 E. Hazelton Ave., Stockton to complete PINK and GREEN FORMS. <br /> Ok to permit as 1624($355)once all fees have been paid and the above has been completed. <br /> The person in charge is responsible for ensuring that the above mentioned facility is in compliance with all applicable sections of the California Health and <br /> Safety Code.If a reinspection is required,fees will be assessed at the current hourly rate. <br /> M7> <br /> Received by: Name and Title: Douglas Montandon, Co owner <br /> EH Specialist: SCOTT SANGALANG Phone: (209)468-3452 <br /> SR0081191 SCO61 09/27/2019 <br /> EHD 16-23 Rev.06/30/15 Page 2 of 2 Food Program Service Request Inspection Report <br />