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49'" SAN JOAQUIN COUN <br /> Z� ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> r... :p Telephone: (209) 468-3420 Fax: (209) 464-0138 Web:www.smgov.org/ehd <br /> '9CjFofiia <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Lo ke C Date: i - ZZ- I <br /> Address: -�3 1 City: Zip Code: c` <br /> Owner/Operator: 32 Q� V-<D <br /> �n Telephone: <br /> Program Element: ,\Ol Program Record: S p Inspection Type: 2,n <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS YAC_ <br /> o. /Z1 <br /> \j <br /> � i b <br /> 1 b Z <br /> VQ0r -F <br /> kms.. <br /> Item/Location Temperature Item/Location Temperature <br /> 'F d Safety Perlificktion Facility Hot Water Temperature Warewashing <br /> Nam Hand Sink: of Chlorine: ppm Heat: of <br /> q1teco A!Exp.D e: Warewashing Sink: 12 of Quat.Amm.: ppm Other: of <br /> Received By/Title: <br /> EH Specialist: Phone: b Y _(D <br /> Time in: + 2� Time Out: ` + Page lof ' <br /> EHD 16-24 (2nd pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />