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SAN JOAQUIN COUN . f <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.sigov.org/ehd <br /> 4t)FORa <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: M(A 11Q_ \ U D l W Itx1r ,/'j C" V-W(ji V-t(V-R+)Date: I V <br /> Address: �U�C. N � � yt G City: , _ I Zip Code: 0 <br /> 1�-��G A <br /> Owner/Operator: U 1 vl" Telephone: c V <br /> �_ 3_�q-1b24 <br /> Program Element: _ , Program Record: U✓ Zcjfo Inspection Type: <br /> SB180 Posted Yes No Permit Posted Yes No J'� Re-Inspection on or After: 1� <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> cuve 4uce Ore S;u .o:EA <br /> Six e L ' off . <br /> 2 c_vk^f•e.ni- px,4m rt- DrcX t a 1�, r " S �- o-r1 <br /> MCA 0 CT\ - 01 1 :bM.P-Ca <br /> Item/Location, Temperature A Temperature <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: of Chlorine: ppm Heat: of <br /> Exp.Date: z-L-)Z` Warewashing Sink: of Quat.Amm.: ppm Other: of <br /> Received By/Title: <br /> EH Specialist: Phone: )-0q _ <br /> Time in: G' . j1 Time Out: ; C, . �( V 'T Page+of I <br /> EHD 16-24 (21^pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />