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oP`t`''''"' c SAN JOAQUIN CC .TY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> _ 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax: (209)464-0138 Web:www.sigoy.orQlehd <br /> 4L+fidRN <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: M O q I (U n - m (Ak Date: � O T <br /> Address: City: +�/�� � Zip Code: <br /> Owner/Operator: n of Telephone:(,' j 2.42q <br /> Program Element: Program Record: a rj Inspection Type. ,te <br /> SB160 Posted Yes No + Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> ,Q o rz i1 C Gik_eS [�'- <br /> to 4e4-A,s v I U crnWk -` <br /> —OY- <br /> 5 (-e C�.QU4A C C11',A <br /> —0� <br /> /11CGn -UN <br /> uh t Ca c t o� TF-+ fi O � v A21n <br /> f0� <br /> Kh7 0 V iA SrX* C/1 w 1 +�- 1 u.� C <br /> 0 <br /> GA-6 A <br /> �r _a f7X C a .ee <br /> S Ply vvWe mcO 12 <br /> Item/Location Temperature Item/Location Temperature <br /> Food Safety Certification Facility Hot Water Temperature warewashing <br /> Name: Hand Sink: F Chlorine: ppm Heat: -F <br /> Exp.Date: Warewashing Sink: of Ouat.Amm.: ppm Other: F <br /> Received By 1 Title: <br /> EH Specialist: Phone:e;D:v`'L�^,r7 — <br /> Time in: Time Out, Page2of �? <br /> EHD 16-24 (2ndpg) 4013 FOOD PROGRAM OIR CONTINUATION <br />