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SAN JOAQUIN COIF 1( <br /> r, :< <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1888 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> 4tiFda ". Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.siaov.ora/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: !�• <br /> ddress: n Lf City: ! .i7jn Zip Code: 52.Q <br /> Owner/Operator: •5 c' LOLJ <br /> yn _ v /7/7 Telephone: .�.c <br /> Program Element: Program Record: to/R 0moa841 Inspection Type: �1 <br /> SB180 Posted Yes No Permit Posted Yes NO Re-Inspection on or After: <br /> SERVATIONS AND CORRECTIVE_ <br /> L <br /> ! a- -f prat wet GS ht 00 G[a q n sh <br /> r 4t. i b ak)/ * r LQQ <br /> h-G <br /> O r r{ - <br /> a Me / I n747 ri <br /> O Si Q4 - U <br /> Cta <br /> 41 IF <br /> yr i h o <br /> 1ho s e a -Ae 'L <br /> -'2707-F,' to Yn-0-IGL Lxle ami r <br /> so A-Cf-s gotr SYnvo C�L2orrcab <br /> Ct cad n0*1 <br /> �M--»- -- -�- Item/LocatwTTemn , Temperature Item/Location pest <br /> � I <br /> [cation Facility Hot Water Temperature Warewashing <br /> rExp. <br /> : Hand Sink: of �-�io­rme: ppm Heat: of <br /> Date: arewashing Sink: of uat.Amin.: ppm ther: of <br /> Received By/Title: r&' <br /> H Specialist: Phone: '7/x,53— -7817 <br /> Time In: : OO Time Out: 011" <br /> " Page)of <br /> EHD 1624 (2ntl Pg) 4/313 FOOD PROGRAM OR CONTINUATION <br />