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OP6WCSAN JOAQUIN COUt <br /> ).•' ' OG <br /> a` y+ ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • c..• �p• Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.siaov.orq/ehd <br /> 4��FORa <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT c <br /> Name of Facility: —� r�'L Date: 10—t-6—t <br /> Address: �• 1 rr� City: +,)Cie � Zip Code: 5 �� <br /> Owner/Operator: Lau <br /> V na Mer 4- I'v Telephone:UoZ_ 3 i <br /> Program Element: 1,(00, .:�) rogram Record: 5 ri s3_ Inspection Type: u _.�.� <br /> 1 <br /> . On <br /> 8180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: T� <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> CU <br /> 'LY1 P L 5 33 Zq 2 3S <br /> i ro �c1e WP-e o m-,f_ an 60+)n i <br /> J <br /> 1l.5 A 0 %.t+ OL- Ltr <br /> On <br /> cc, i s w <br /> LA_;Ve 8 b &o d anCA <br /> V-8 <br /> DS� S•� n w�nc� <br /> o Y K +10 vss w4e, wv► 4- o-G�R cg_ <br /> c� ra 'b-5 -e e 4 23� <br /> Item/Location Temperature Item/Location Temperature <br /> 61 f - <br /> WR Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: of Chlorine: ppm Heat: of <br /> Exp.Date: arewashing Sink: J�O 'F Ouat.Amm.: ppm Other: 'F <br /> Received By/Title: CJ <br /> EH Specialist: v Phone: (moi _ n r� <br /> Time in: Time Out: _( /D Page of <br /> EHD 16-24 (2nd pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />