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SAN JOAQUIN COU..XY <br /> a ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> 4c Fdk� 6 Telephone:(209) 468-3420 Fax:(209) 464-0138 web:www.s'Qoy.org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: L.A"_� Date: <br /> Address: a 1 City: G/C Zip Code: 2- /6 <br /> Owner/Operator: L u Telephone: (b <br /> Program Element: 3Z Program Record: PR Inspection Type:-,-,d <br /> SB180 Posted yes No Permit Posted es No Re-Inspection on or After: cl <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> VL.®�O( f7 B77 S <br /> I ° f ° <br /> rri to <br /> 0 <br /> too Ce ✓ �' y0° <br /> Facility <br /> ame: r and Sink: X37 eF hlorine: PPM t: ��(p Q'F <br /> Exp.Date: / are w sh' Sink: eF t.A r)n.: OD PPM ther: -f <br /> -lay <br /> Received By/Title: �l <br /> EH Specialist: /_L\ Phone: q53- <br /> 5 ` <br /> ime in: G` Time Out: _c/ • " PageZof 2 <br /> EHD 16-24(2n0 pg) 11/2/09 FOOD PROGRAM OIR CONTINUATION <br />