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1—cLU <br /> °4'" SAN JOAQUIN CO, TY <br /> Q' ya ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • .., �p• Telephone:(209) 468-3420 Fax: (209)464-0138 Web:www.s*gov.org/ehd <br /> 4GjFOR�1 <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Mn r- (--- Date: <br /> Address: e—o c City: Zip Code: <br /> Owner/Operator: J Telephone: <br /> Program Element: Program Record: L 0 vJ Inspection Type: <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS , <br /> iS � t ' \ r <br /> rD itk Aw <br /> 44 <br /> ✓ CZD - <br /> �1 g o cab <br /> Ce <br /> d0 <br /> ©o <br /> U,u /7dlt� le. AVt4?..(V rls% S ic <br /> Item/Location Temperature Item/Locatio Temperature <br /> _ I <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: of Chlorine: PPM Heat: 'F <br /> Exp.Date: Warewashing Sink: of Quat.Amm.: PPM Other: of <br /> Received By/Title: <br /> EH Specialist: .T Phone: q �S <br /> L C+� _ O -3;Time in: \J Time Out: E7 Page of <br /> EHD 16-24 (2n°pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />