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i <br /> SAN JOAQUIN COL -Y <br /> z 'y ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax:(209)464-0138 Web:www.sigov.or /q ehd <br /> L�FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT 3Y.2-$95� <br /> Name of Facility: mU r e n-v ro � Date: <br /> Address: 2 8 23 s L2 �� City: .1_ � Zip Code: 95 ZQ� <br /> Owner/Operator. r ftC c Orl 7-/iQ l a n 7 --' q 6nJ� rri' r Teleph .� <br /> J cNU C., �f.3 ri <br /> Program Element: /6Program Record: Inspection Type: <br /> SB180 Posted JkWes No Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> --SIC, 209.33 <br /> - ------ - ----- --1J�� f b Y 0 8 i 4 a Ry'IQ 0 X35 .o' <br /> —-._..._-- _......._ _.._...._....- ----....—_...._... <br /> __. - ------ -------...--._._..- --- -- ----...__. <br /> -..............-..._...___.-.........__.__... <br /> -- a------ --._ . ....................... ........._....... <br /> 1 L _.._._.._....._..................................._....._.._............._._.........-- --- <br /> (`� <br /> iiemlLocation " Temperature 'I Location ..;_ - Temperature <br /> Food Safety Certification Facility Hot Water:Temperature. Warewashing <br /> Name: Hand Sink: OF Chlorine: ppm Heat: °F <br /> Exp.Dat Warewashing Sink: OF Quat.Amm.: ppm Other: OF <br /> Received By/Title: �r ,c ► �f'/f�,,z-4/ / <br /> r.) <br /> EH Specialist: /_ Phone: <br /> Time in: Time Out: �l �F O� Paget of <br /> EHD 16-24 (2^4 pg) 4/3113 FOOD PROGRAM OR CONTINUATION <br />