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SAN JOAQUIN COUNT <br /> X ENVIRONMENTAL HEALTH DEF ,tiRTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax: (209)464-0138 Web:www.sogov.org/ehd <br /> �iFORa <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: L C , \, `� ��a`.' Date: / S <br /> Address: W9FG� City: r_,j •l Zip v Zip Code: <br /> Owner/operator: f , Telephone: <br /> Program Element: �C) Program Record: ('c!U Q q 5� I Inspection Type: Cum 1o'n 4_ <br /> B180 Posted ❑Yes ❑ Rermit Posted 1 ❑Yes) ❑1 Re-Inspection on or After: <br /> E <br /> I,icQn # 2 N I U 3U hcr�- Civ 4e U 1(A c� � U:5�,C tIL <br /> n-I s" Uniun s,t % . W U . <br /> -TO(Us <br /> -- � �� una }r w•l� � �e i-�- <br /> - Sof +c> rCW _�_ GA MANl an CA C'Ko <br /> S & .\,k •rhe hIA L <br /> GI j 'rfA L_U � Qif za+�f S <br /> Ua �1� fi 7s <br /> Name: Hand Sink: of Chlorine: ppm Heat: of <br /> Exp.Date: Warewashing Sink: of uat.Amm.: ppm ther: of <br /> Received By/Title <br /> EH Specialist: Phone: OG <br /> Time in: 2 Time Out: ; ,L� Page +of <br /> EHD 16-24 (2n1 pg) 4/3/13 �l FOOD PROGRAM OIR CONTINUATION <br />