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"g"I" •� SAN JOAQUIN COU <br /> z-� 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 /> �IFOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: m 0 n + /S.VrL_'0 Date: <br /> Address: I coI� _+--e4 Mo Sk City: Cx- Zip Code: 5""`_ <br /> Owner/Operator: A l PU1Li Telephone: la, <br /> g -9 <br /> Program Element: 1 r) Program Record: P PLO <br /> Inspection Type:20 V-H r7--P— <br /> S131 80 <br /> --P—SB180 Posted')(,Yes No Permit Posted*Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> In I'Y1 _GI v» J Gf !ce ( p L7 A c*� 43 s ervi 5 fife <br /> ors . (Z-,e rrLy v,!_! f -S a—1-z+-i v r <br /> C'WCe r WL. -j l NI d�,r,-en u • I ,,,o Y-e-4-e r . 1 ro v'1' ae_ IV <br /> u c4we .e. sa4k� t bCt w <br /> AV-67.' U.S t,-I +rrc.e. _as u tPu C, tlea I+JI C-0 P?+YO f . 1� .:P C6 <br /> Item/Location Temperature Item I Location Temperature <br /> (- ll <br /> If rA{AV &s <br /> tr 31t <br /> yr .o,' q° 5cin (4('9r <br /> Food Safety Certification Facility Hot Water Temperature Warewashing, <br /> Name: ol hQ ki Hand Sink: 2 'F Chlorine: ppm Heat: 'F <br /> Exp.Date: ,i ( I�3_ a washing Sink: of Quat.Amm.: ppm Other: of <br /> i <br /> Received By/Title: �� ! <br /> EH Specialist: t Phone: 5 I <br /> Time in: (, ) I 'f0 Time Out: L O,00 Page <br /> -.;P-f 2 <br /> EHD 16-24 (2nd pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />