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P4"'" SAN JOAQUIN COUN . <br /> X ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax: (209) 464-0138 Web:www.sigov.orq/ehd <br /> �1FORt� <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: M -� o •-) uc Date: U 23 ) <br /> Address: U� City: Zip Code: 1 4�— <br /> Owner/Operator: �-,n :r f Telephone: 139rb - 3611(� <br /> Program Element: ( ( Program Record: f Inspection Type: f1 k� <br /> SB180 Posted 1I�v ❑Yes ❑ Rermit Posted 1 Yes F1 Re-Inspection on or After: W ` <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> c i c!z Cav,�r i i- tau .e G-t <br /> a - <br /> SCCA C tCA' I bOve h a Ord <br /> nm,- ;tet n S cm . CcN 0r 1b_P__ <br /> i�.e rS n i 01 �vr t-S <br /> tP 120 d I . <br /> 0 r \Aa S Wt s 0 W-MW r <br /> o Y ea v 11fZ i ric;iThe i�zbi b&f - cwcrve wasq. <br /> 5 v do _�n� O SU � i nsi JQ i}up_ <br /> TS0WF-. CW 04 ltJCA . <br /> Item/Location Temperature Item/Locationi Temperature <br /> Food Safety C,ertifiaati02 _ Warewashing <br /> Name: 1 e r /� <br /> 7Hand Sink: �� a Chlorine: h_ ,�( ��Heat: <br /> F t'� PPm F <br /> Exp.Date: ,4 �—� washing Sink: I of Quat.Amm.: PPM (Other: 'F <br /> Received By/Title: <br /> EH Specialist: Phone: i[l <br /> Time in: �I� Time Out: �` ' �f Page f <br /> EHD 16-24 (2""pg) 413113 FOOD PROGRAM OR CONTINUATION <br />