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r: � I I I Environmental Health Department <br /> N <br /> Y U <br /> f�■■z�ti� COUNTY <br /> Greorness grows here. <br /> Food Program Service Request Inspection Report <br /> Facility Name and Address: MOUNTAIN MIKE'S PIZZA, 19677 S MOUNTAIN HOUSE PKWY, MOUNTAIN HOUSE <br /> OBSERVATIONS <br /> Name on Food Safety Certificate: needed Expiration Date: <br /> Warewash Chlorine(Cl): ppm Heat: °F Water/Hot Water Ware Sink Temp: 120°F <br /> Quaternary Ammonia(QA): ppm Hand Sink Temp: 100°F <br /> FOOD ITEM--LOCATION--TEMP°F--COMMENTS <br /> No Temperature Data Collected <br /> NOTES <br /> Food plan check pre-final inspection <br /> Submit a photo of correction for Item#7 prior to issuance of a permit. <br /> Permit not issued this date. <br /> No signature obtained <br /> Report typed in the office 4:23p-4:35p <br /> The person in charge is responsible for ensuring that the above mentioned facility is in compliance with all applicable sections of the California Health and <br /> Safety Code.If a reinspection is required,fees will be assessed at the current hourly rate. <br /> Received by: Name and Title: discussed w/Victor Panaich, owner <br /> EH Specialist: KADEANNE LINHARES Phone: (209)616-3025 <br /> SR0084212 SC523 11/08/2022 <br /> EHD 16-23 Rev.07/05/2022 Page 2 of 2 Food Program Service Request Inspection Report <br />