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SAN JOAQUIN COUt <br /> Q` ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax: (209)464-0138 Web:www.s*Qov.org/ehd <br /> L/FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: L I�; r Date: S' 2_0 '4 <br /> Address: I f h , ' City: --Y Zip Code: <br /> Owner/Operator: Telephone: <br /> C <br /> Program Element: Program Record: Inspection Type: <br /> Re <br /> SB180 Posted Yes No Permit Posted - Yes :-; No Re-Inspection on or After: <br /> ns e <br /> P', <br /> cord G r ; .. 5 ; n /e USe <br /> 10M.5 4o ce C,f. CoTrocio S. <br /> i In y 0 'r124 A b a-G <br /> K ) h . <br /> $ C' if l on )1P c-d G j . be a d Cc1r•c4 -'y <br /> 3 sr l n re a1 � n S � r ; Sun • �,T <br /> lee I <br /> ItemJLocation Temperature Item J Location Temperature <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: n�u� 16 n G/1 S Hand Sink: of Chlorine: ppm Heat: F <br /> Exp.Date: //� Warewashing Pink: of Quat.Amm.: ppm Other: of <br /> Received By/Title: 4 (r- <br /> h <br /> EH Specialist: i� Phone: <br /> Time in: !l a� Time Out: Page of <br /> i <br /> EHD 16-24 (2nd pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />