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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> . .. ;P. Telephone: (209) 468-3420 Fax: (209)464-0138 Web:www.sjgov.or /g ehd <br /> 4C%F�Rt� <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Lh S ' Date: '1 D f <br /> Address: A 30 � <br /> h U City: �•�� Zip Code: / 52G2G _ <br /> Owner/Operator: %T( \ 1� QT � a1 Telephone: " (_ „15(00 <br /> Program Element: ,lat Program Record: 6 1ba S Inspection Type: �(!� 1 �'C-- <br /> SB180 Posted es ❑ No Permit Posted es ❑ No Re-Inspection on or After: <br /> OBSERVAfI©NS ARID CORRECTIVE ACTIONS <br /> lo}- S Ure Cor:P-.Zl in COOS. CC)TTe_C7i- <br /> 2 W(JIB Ci- 3 -CCfM V t 4- 110 "", u.S� to 120`'= <br /> ar <br /> 1vu r (CM 'jfj r, & ud �s 1 cyce $inti . min a <br /> T-11I \/0 tocky. <br /> 4..F . 9fd \)St TP ArLf CIV b00'j�j <br /> dG <br /> � 0'j m h cTirLe <br /> dr '.,e i <br /> w 1 rooter I <br /> 3 dr I n 41`� <br /> Name: 1 Hand Sink: C)O of Chlorine: ,�v� ppm Heat: of <br /> Exp.Date: ` /N arewashing Sink: of Quat.Amm.: ppm Other: aF <br /> Received By/Title: <br /> EH Specialist: Phone: 3 <br /> Time in: `; Time Out: 75— PagUIDQ <br /> EHD 16-24(2n1 pg) 4/3/13 FOOD PROGRAM OR CONTINUATION <br />