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aa"!" SAN JOAQUIN COUN <br /> 4 .z� ENVIRONMENTAL HEALTH DEPARTMENT <br /> X <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax:(209) 464-0138 Web:www.segov.org/ehd <br /> Lr�oa <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: L �w � ' Date: <br /> 777 <br /> Address: City: Zip Code: <br /> Owner/Operator: Telephone: <br /> Program Element: lyq V Procyam Recor Inspection Type: �f� <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: /� nvl�j <br /> w, OBSERVAT#C?NS AND CORRECTIVE ACTIONS <br /> S-......... <br /> --_wit <br /> i <br /> - tlu vn 4ct <br /> 2 <br /> . Jl,o S"7 F <br /> - a <br /> V i✓�l✓;'�/� ( Ivi-e 6-4 ,Ue�,j/!_ <br /> -< '• a"Y Item/Location ; Temperature Item/Location Temperature <br /> 4, <br /> � <br /> Gi4 <br /> ilt 14 6A-f 40 <br /> Pood Safety Certification Facility Not water Temperature ,_ war�tiva ping - <br /> Name: Hand Sink: "F 'Chlorine: ppm Heat: `F <br /> Exp.Date: arewashing Sink: OF Quat.Amm.: ppm Other: OF <br /> Received By I Title: <br /> EH Specialist: Phone: <br /> Time in: Time Out: Pag t- <br /> END 16-24 (2^ pg) 413113 FOOD PROGRAM OR CONTINUATION <br />