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SAN JOAQUIN COW <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 /> �rFdR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: -Le. <br /> ii 1.. Date: ��_� <br /> Address: �u2 , 1 „yea rcl� / _ City: ��� �(J Zip Code: <br /> Owner/Operator: S I ��l Telephone: y <br /> Program Element: 1a 1 Program Record: /� 2 Inspection Type: <br /> /1 2zy U_ <br /> S6180 Posted es ❑ Permit Posted 14 Yes ❑1 Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> e5 <br /> Wo r arc•- �9 r.� e ✓le4_ <br /> >Q <br /> Item/Location �• ' e,g-, Temperature Item!Location : Temperature <br /> n �� _ �� Lel"r <br /> y 1 c <br /> _ L <br /> oName. <br /> r LameFood�SafetyFacilityHot Water Temperature �t Warewashing <br /> a J�t7 r Hand Sink: of Chlorine: 0 ppm Heat: F <br /> _ <br /> el <br /> Exp.Date: / arewashing Sink: l of Quat. Amm.: ppm Other: of <br /> Received By/Title: <br /> EH Specialist: L Phone: '?,53 99 <br /> Time in: Time OuJ. 1 L 7 t: <br /> J , Pagef <br /> EHD 16-24 (21 pg) 4/3113 FOOD PROGRAM OIR CONTINUATION <br />