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a"!" SAN aJOAQUIN COUN' <br /> 4 y� ENVIRONMENTAL 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 /> Lracod <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: I 9, Date: <br /> Address: 72'3 1PJKe <br /> , +Ie ch Ln ' City: L_.0 CL I Zip Code: 2142_ <br /> Owner/Operator: M 0. acLt G Telephone: <br /> Program Element: ' .,2_6 Program Record: 5_07q97 Inspection Type: t/ <br /> [fL8OPosted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> QBSERVAT1oNS AND CORRECTIVE!A Ti N <br /> : .:. �_� . �.�.��:�....... .. . ....... . �,,a . <br /> CL) T,kQG_ScXacL 5 5e r"f' iS 154-arecl-c h tf-oQ_ F/ac..- /- e k r V lt. Sa r <br /> Oc(( fnn* 4l-,Qi •k d f <br /> 2 Tltie a tis i-n_ o hc_ (ems{- do:) o r. {t-%— 2 0 oc�_ <br /> 0.iv.Q mdece K ciLle- .- <br /> go.k rS <br /> 14L q <br /> Item/Location ` Temperature Item/Location Temperature <br /> ........................ . ...._:_ - — ----- <br /> `-� T-or►1��5 �-fL��J�' <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: - Hand Sink: rJ F ��.._� Chlorine: -- -, <br /> Heat: <br /> Gtv- G.i i`-ZC�. >`tiw✓�._Name: ] <br /> � c. Ppm — -- F <br /> Exp.Date: _ / I arewashing Sink: 170 of Quat.Amm.: PPM Other: o f <br /> Received By/Title: II <br /> EH Specialist: Phone: I-(&g-31-ell( <br /> Time in: Y Time Out: 3 Pa e•Zof Z <br /> EHD 16-24 (2°pg) 4/3+13 FOOD PROGRAM OIR CONTINUATION <br />