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PC-k SAN .IOAQUIN COUN <br /> �o c <br /> . —aC� •.OG <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.sigov.org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: M (A/�,�G- Ct Date: 3 G <br /> Address: [ W,l M City: lle Zip Code: <br /> Owner/Operator: Telephone: <br /> Program <br /> Program Element: 1 Program Record: j;M1 Ins v tion Ty <br /> SB180 Posted Yes No Permit Posted Yes No Re-Insp #tion on or After: <br /> a <br /> � lite.G� h.. <br /> • ''i <br /> UY Gf� <br /> YL✓ ' i VtJ W lH a1� o" <br /> C�w �l <br /> ftyv - 11 1 AIA C(kt ry� �J <br /> l l"0 <br /> K� kt� utv4( / d <br /> ✓d roc tub I vi, ur <br /> ft-MN VGWS IWL4 ah d <br /> s + j vLW sII4, 1h d i✓le m <br /> r(lo, Y4 YPV1 he' Zvi <br /> U h <br /> 0 � r Of ! P kV ►� <br /> Temperature., <br /> Tem <br /> Item/Location Temperature Item/Location <br /> P � P <br /> I <br /> oak h0k1L + <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> -.._. _ ...._.._ .-...---- ---- --- <br /> Name: Hand Sink: of Chlorine: PPM Heat: of <br /> Exp.Date: Warewashing Sink: of Quat.Amm.: PPM Other: of <br /> Received By/Title: / p <br /> EH Specialist: / Phone: <br /> Time in: Time Out: r Page of <br /> EHD 16-24 (2nd pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />