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SAN JOAQUIN COUNTY <br /> � •.OG <br /> y„ CNVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax:(209)464-0138 Web:www.s*gov.org/ehd <br /> ��FORtN <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: �_ -- L�c o-1 Date: 2 <br /> Address: I 25waf{ r) City: �la5 <br /> Zip Code: C <br /> Owner/Operator: O t o l Q r c1 Telephone: 451 - 4-+--+(,o— <br /> Program Element: , o5 Program Record: C)V5 2q 1>76T Inspection Type: <br /> SB180 Posted Yes No Permit Posted Yes No t T Re-Inspection on or After: 1 v1 <br /> OBSERVATIONS ANCI CO'R'' IYE ACTIONS <br /> 12 <br /> _ • 0 CkhcX�S cvr�re - - <br /> i Ockw <br /> At'dQ <br /> Item/Location Temperature Item!Location Temperature <br /> 17 -- — - <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: of Chlorine ppm Heat: F <br /> Exp.Date: arewashing Sink: of Quat.Amm.: ppm Other: of <br /> Received By/Title: <br /> EH Specialist: Phone: <br /> Time in: �li '(00 Time Out: 11 , 15 Page of <br /> EHD 16-24 (2nd pg) 4/3/13 FOOD PROGRAM OIR CONTINU TION <br />