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.r- <br /> °a""" SAN JOAQUIN COL 'Y <br /> 4 'a ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.s4gov.orq/ehd <br /> L1FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT 3Y-2-$95S <br /> Name of Facility: mo r e n-v r-0Date: _/0-16 <br /> Address: a 8 as City: 6.kD�.�ti Zip Code: 95:io <br /> Owner/Operator: �, nc 5 gn 1�1IQ o 4 4 h OCU q 0a Telepi)M Ir be <br /> Program Element: // Program Record: Inspection Type: u <br /> SB180 Posted es No Permit Posted Yes No Re-Inspection on or After: <br /> my, a OBSERVATIONS AND C�pRRECTIVE AC3"�ONS <br /> a D 9'3:3 G-t --- __..__................. _ <br /> !i'Q 8 R z R Vfl D _.......-.._...._........._o....._K.-- <br /> -- ...................... . _ . ----- _ _..__ ___._—--------------------------- -------------- -... <br /> f'R_ 5 .— �- _. _� L__ ............................_..............---....... <br /> Z x away NA- 3 !o 5 O 'c <br /> - -- -------- -- _ .. -_..... ................. __-- -- --------........ <br /> ..._.......... <br /> temf.ad�I '� einperature ,1tem 1 Locat+on �A Temperature <br /> _. <br /> a <br /> Food Safety Certification15 <br /> cifi[yolNatereYllarewashing <br /> Name: Hand Sink: of Chlorine: ppm Heat: `F <br /> Exp.Date: Warewashing Sink: -F Quat.Amm.: ppm Other: of <br /> Received By/Title: <br /> EH Specialist: - Phone: 1* 3 —'78/? <br /> Time in: 00 Time Out: j 0!O, Paget of � <br /> EHD 16-24 (2n1 pg) 4/3113 FOOD PROGRAM OIR CONTINUATION <br />