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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> . •. iP• Telephone: (209) 468-3420 Fax: (209) 464-0138 Web:www.sagov.org/ehd <br /> S�/Fo•R�i <br /> LoMr- MGN,Weds, <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT *''�' �� <br /> Name of Facility: LOL I WeT 06-ft1)c0 Date: �a/ A/ 14 <br /> adress: `3c�10 t. 1 City: S17)C�F1'L)r zip Code: g62_4 <br /> Owner/Operator: by L 1,�r i-; Telephone: `c1flo'I _O rho <br /> Program Element: (0 I5 Program Record: �F 6 ItoI 2-.7b Inspection Type: bre 4b <br /> SB180 Posted Yes 0 No Permit Posted VYes E No Re-Inspection on or After: � W eQ',S <br /> RS AND WR EC_ A TiONS> <br /> ReM14 DOh l- Th, Q ' t112 . U -Fuat l i <br /> St YfS Som aS 0sS 117 <br /> �e <br /> ed 'Raw Mea+ n w Fye -- <br /> b I s -h n clFa h of fi AOt <br /> e <br /> 3 P�a�r�r boa 1 S��Z 'f2slPooM�ex�la _ - <br /> �c sjn4VecAilqn p"o`+ r o-� vcx1laW o a c <br /> G C/T d r►e 4est- WIF5 N r\ <br /> d r -T� <br /> Name: Hand Sink: aF Chlorine: ppm Heat: of <br /> Exp.Date: arewashing Sink: of Quat.Amm.: ppm Other: of <br /> Received By/Tit <br /> EH Specialist: Phone: ePt _ �s _34 4 <br /> Time 06J I <br /> Time Out: It , I Page2of Z <br /> EHD 16-24(21d pg) 413113 FOOD PROGRAM OIR CONTINUATION <br />