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at^4H•"• SAN JOAQUIN COUNTY <br />1 �'A <br />y ENVIRONMENTAL HEALTH DEPARTMENT <br />N: K <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />c'UFa'aNp Telephone: (209) 468-3420 Fax: (209)464-0138 Web: www.sigov.org/ehd <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />Name of Facility: <br />s M <br />S kn k <br />Date: 12--1-'Z2, <br />Address: , (� �5 L <br />�1J 'Z <br />City: L ter\ e <br />Zip Code: g S 2 a b <br />Owner/Operator: C1• \ 5 <br />Ce (1 <br />Telephone: . <br />Program Element: <br />Program Record: c ti,A <br />J c 9 2 <br />Inspection Type: <br />B180 Posted Yes No <br />Permit Posted Yes No <br />Re -Inspection on or After: <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />1 <br />IS <br />'�11N S <br />55C 2 <br />W S S <br />C C \ <br />'lam <br />mlLocatioo <br />- - <br />Temperature <br />Item I Location <br />Tomperature" <br />2c� fin-, <br />r e <br />— <br />C. C <br />_ <br />C <br />_ <br />Food Safety Cert_ ification <br />- Facility Hot Water Temperature <br />_ _ Warewashing_ <br />NameL 1�.. pw nce-(�Z•. <br />Hand Sink: <br />�2 of <br />Chlorine: <br />PPM Heat: F <br />Exp. Date: 2.- \ -, 2 <br />arewashing Sink:\ <br />2 1 of <br />oust. Amm.: <br />Ppm ther: 'F <br />Received By I Title: <br />EH Specialist: C <br />., <br />Phone: <br />2_0P\_ 1 _ 1 \0- 3\3ZS <br />Time in: 5\ <br />Time Out: <br />�-IS C>-V� Page of <br />EHD16-24 (2wpg) 48113 FOOD PROGRAM OR CONTINUATION <br />