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oP4"I"' SAN JOAQUIN COU: ' <br /> W: X ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> �q..• -•..•�� Telephone: (209) 468-3420 Fax: (209)464-0138 Web:www.sigov.org/ehd <br /> LIFORd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: n <br /> IIN Dam �Z ��� Date: c� <br /> Address: Cer►- e r City: -f-0 Zip Code: G 2-0 <br /> 2 <br /> Owner/Operator: <br /> Telephone: al 37_Oc?2�5 <br /> Program Element: Program Record: P #Z C) - 7 Inspection Type�v� <br /> SB180 Posted ')!,Yes ❑ Permit Posted Yes ❑( Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> e '16o4ji h a r, a s 4 zvt_4 i d-»_a Y a c., - v of r 1-9 w_ejs 0 rc�_ <br /> n 3 <br /> " <br /> 6 s'Ta4onSLP r _ g� r-e !i7 5 o 44--6o <br /> vii AL4'-6 7,9,x- 4-1 o -- usi rr <br /> w co 0 <br /> Y 11 a h ex <br /> LX-4 <br /> Uh.s <br /> 4zx m <br /> L) r <br /> t �—r <br /> Item/Location : Temperature Item 1 Location Temperature <br /> ch,0-e S-C_ G� vo <br /> tA c r 9`I ow_ el �►� <br /> Food Safety Certification <br /> _,. _ Facity Hot WaterTemperature Warewashing <br /> _. _ ._ iail <br /> Name: VA�/"l n��a Hand Sink: /ia J �� of (Chlorine: �l� ppm Heat: of <br /> Exp.Date: f� a washning Sink: <br /> the <br /> —LU3 of hv✓ 4 .� ppm of <br /> Received By/Title: <br /> EH Specialist: V Phone: g )2 <br /> Time in: © Time Out: O O Pag of <br /> EHD 16-24 (2^'pg) 4/3/13 FOOD PROGRAM OR CONTINUATION <br />