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0 SAN JOAQUIN COUNO <br /> _ ENVIRONMENTAL HEALTH DEPARTMENT <br /> Nt <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax: (209)464-0138 Web:www.sogov.org/ehd <br /> �!F°R <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: �01 MG'f CAIl�_o Date: <br /> Address: �_G OU F, . jzy1 City: S' _Ocx- ' Zip Code: ClS.1-D� <br /> Owner/Operator: '=Sn uel c ioruU 2_ qf)ro- t �C�(j Telephone: el—of <br /> Program Element: IIOO` Program Record: GU�� A-fS Inspection Type: <br /> SB180 Posted ❑Yes ❑ Permit Posted c Yes ❑I Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> d IlKe oV_,nru`S keuSt- atic 's:-yk <br /> i rS id .+ <br /> F00d NTAh CGtrd CAIP�tM F 1 Pe <br /> V Ah-kn <br /> 1h& fl CVT i S S \%P-4c"- tMetzAN (c\Icavcw0 <br /> arra �uS� <br /> cc,Jt�1 rLwacle ccjvlcq <br /> Ftem/Location Temperature Item l Location Temperature <br /> Food Safety Certification ility Hot Water Temperature Warewashing <br /> Name [Ha,�dlink: Chlorine: Heat: <br /> 1 5� ) C"lA V_kACA 1 U U o f PrvCi+ ppm 'F <br /> Exp.Date: S / 2 arewashing Sink: 120 of Quat.Amm.: ppm Other: of <br /> Received By/Title: --' <br /> �%Cvc <br /> EH Specialist: Phone: <br /> 'xCg - 4(a-b -J <br /> Time in: ;.SL) Time Out: Q Page "of <br /> EHD 16-24 (2°'pg) 4/3/13 L FOOD PROGRAM OIR CONTINUATION <br />