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SAN ..IOAQUIN COUN14 <br /> yENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> . �.., r_ ;b • Telephone:(209)468-3420 Fax: (209)464-0138 Web:www.sigov.org/ehd <br /> 4�iFORN <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: L . 6 n `, S 4::�) 3 :1()i C, ' r•y1 r v Date: 2 7-/ Z <br /> Address: 3 01 o 6 ro n 4 L, r\e City: -Tref r Zip Code: 9 53 � 6 <br /> Owner/Operator: j Telephone: <br /> Program Element: ` Program Record: S R U V o Inspection Type: Plan C h C <br /> SB180 Posted ❑Yes ❑ No Permit Posted ❑Yes ❑No Re-Inspection on or After: <br /> OBSERVATIONS AND'CORRO-FIN ACThONS <br /> �MPro Lj; CGShi dr -; n -3 <br /> �� Anf� S n � �S 1 Cn Pr �2� F <br /> , Irr <br /> Fins r, a II a ' � r �•I -, 11� � , <br /> ChrGi, Ari n < lir <br /> ;E' <br /> 0. <br /> 0. k s +o CKC 44. <br /> h 1; <br /> r L A 1 Y c`C,177 5 <br /> r r'0 V • z_ av, r- n 3 4rv>c/ s. LOfJrP <br /> Pro Y :�( 011/71 'Wc1 401- &r c� S �Gr.ra <br /> � 1 <br /> Item/Location Temperature Item/Location Temperature Item/Location Temperature <br /> d <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: 2 U of Chlorine: ppm Heat: of <br /> Exp.Date: Warewashing Sink: of Quat.Amm.: ppm Other: of <br /> Received By/Title: <br /> 14 oe <br /> EH Specialist: Phone: 3/ <br /> Time in: t�. y Time Out: l�/1 0 e' Page of I <br /> ' 1 <br /> EHD 16-24(2nd pg) 4/9/12 FOOD PROGRAM OIR CONTINUATION <br />