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SAN JOAQUIN COUK <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sigov.org/ehd <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />Name of Facility:LA � <br />Date: <br />Address: 1. City: <br />Zip Code: <br />Owner/Operator: <br />Telephone: <br />Program Element: y Program Record: V ^I Sp O� <br />Inspection Type: � <br />61 80 Posted Yes ElRermit Posted Yes ❑ I <br />Re -inspection on or After: <br />J <br />Ite 'iLocation �'` = <br />Temperature <br />Item I Location <br />Temperature <br />/ 3r <br />m <br />' � 'l L 1. <br />. <br />Name: I/t� ,4 i <br />Y, <br />= ro <br />I �r <br />Facility Hot Nater Temperature <br />Hand Sink:I 1 of <br />Chlorine: <br />Warewashittg <br />ppm Heat: <br />of <br />Exp. Date: <br />� o <br />I <br />arewashing Sink:[ 1 <br />of <br />Quat. Amm.: <br />ppm <br />Other: <br />of <br />Received By / Titles <br />EH Specialist: <br />Phone: <br />r1 <br />�j <br />ime in: <br />Time Out: <br />Page -,of <br />FHF)1n-7d 010no) 4B'Z <br />