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SAN JOAQUIN COUNTY <br /> ENVIRr''JMENTAL HEALTH DEW` )TMENT <br /> �. . 600 E. Main Street, Stockton, CA 95202-3029 <br /> Telephone: 209 468-3420 Fax: 209 464-0138 Web: www.sjgov.org/ehd <br /> FOOD PROGRAM OFFICIA NSPECTION REPORT <br /> Name of Facility: Date: <br /> LGA L a ra�vw*2 6AR- C <br /> Address: � � City: � Zip Code:S 45 3!7� <br /> OwnerlCtperator: �tG �0 e4 Telephone: <br /> Program Element Code: / Program Record ID: d<zb Inspection Type: <br /> SB160 Posted Yes ❑ No Permit Posted es ❑NoReinspection On or After: �1 <br /> 'UBSERYlA J01�4, t " f�Rt�ECT��E waft <br /> trr� ss .� <br /> Dkir6b VALLI i c Lar �d <br /> M&5&0W Ir r <br /> �c u(50— <br /> Tolh<T` A0001-5 l k e"e, aFra4� l'Li 674-m rU <br /> f3 5 CbQ Q L�,'zi <br /> UI�7�R �5 <br /> )FA <br /> r7'( SY , R 6 616ow-5 e R-re n,--tZ-4-&S—C-ST d1 ARkA-J <br /> 7w-111-75 <br /> I <br /> � �';1�`do�: _. ::.,�. Te___ ._ �item�.�ocption� �,� a rri''1u hurt <br /> w.d <br /> � .. ctlt ' sitWale rnp rem_ .. tare4s el <br /> r Saertlfic�twn° i. <br /> Name: Hand Sink: °F Chlorine: ppm Heat: °F <br /> Exp.Date: Warewashing Sink: °F Quat.Amm. I } ppm Other: ppm <br /> ENVIRONMENTAL HEALTH AND SERVICE CHARGE FEES ARE AUTHORIZED BY RESOLUTION OF THE SAN JOAQUIN COUNTY BOARD OF SUPERVISORS. <br /> ALL DOUMENTED CRITICAL HEALTH VIOLATIONS OR REPEAT VIOLATIONS ARE SUBJECT TOA REINSPECTION AND REINSPECTION FEE. <br /> Received By: Title: <br /> EH Specialist: V Phone: G� _ r <br /> Time In: ) Time Out: t• <br /> 1 Page: of <br /> EHD 16-23(2ND PG) UU FOOD PROGRAM OR <br />