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SAN JOAOUIN COUP,' <br /> N: ,: X <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax:(209) 464-0138 Web:www.slgov.org/ehd <br /> C/FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Llj� j Date: j/J111 �3 <br /> Address: r„6o 1�4 , r n,jsi- City: 9_b M1vrZip Code: <br /> Owner/Operator: %Q kAd Ck\.,/A k G 0-kT-ZVOS G°J�2 <br /> Telephone: <br /> Program Element: 1 V2 4 Program Record: pR G'b Inspection Type: <br /> SB180 Posted Yes No Permit Posted es No Re-Inspection on or After: <br /> w OBSERVATIONS AND CORRECTIVE ACTIONS <br /> SUsne i ave omd 011 5 kve <br /> n �- -W-)e l i <br /> 3 W Ca S M- GWCA110ble ( �Vvvwe as g <br /> as i C <br /> Th 'TC006MWNQ is - Ae <br /> o A. 3 ,e CA tie <br /> ik Q '266 <br /> bSQrr v e 0,; a b 5 i�c1 S <br /> b Pr oms are hCJV TS sem- a+ /P s <br /> 6-yA de . . <br /> m,)N a <br /> GbW6091 <br /> Item/Location Temperature Item/Location w Temperature <br /> of r _ 13� <br /> wiz coo-U f q 1 of <br /> 2 dr b 18 eAd ai <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: `L�i `F Chlorine: ppm Heat: of <br /> Exp.Date: Warewashing Sink: Z °F Quat.Amm.: ppm Other: of <br /> Received By/Title: — <br /> EH Specialist: Phone: _ �D <br /> Time in: 0 . Time Out: it 1 O Page'_ofZ <br /> EHD 16-24 (2^d pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />