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SAN JOAQUIN COUN . <br /> Za ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> �4..• ' •.�;;P Telephone: (209) 468-3420 Fax: (209)464-0138 Web:www.s'gov.org/ehd <br /> �tFOft <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: L C( II( f Date: <br /> Address: ` S City: rlZip Code: <br /> Owner/Operator: Q Telephone: <br /> Program Element: � 35- Program Record: O j Inspection Type: JRQ �T i <br /> Aj <br /> SB180 Posted ❑Yes 11Rermit Posted ❑Yes ElI T Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> -A Gr _AA6LW c <br /> r <br /> � n <br /> e <br /> w0 <br /> r <br /> ► r)A rvl <br /> Item/Locati temperature 1 Item/Locatio " <br /> Food Safety Certification Facilit Hot Water _ <br /> F, y y Temperature Warewashing <br /> Name: Q r Hand Sink: ! of Chlorine: ppm Heat: °F <br /> Exp.Date: i U / 7-0 arewashing Sink: , 2-0 of uat.Amm.: ppmOther: °F <br /> Received By/Title: <br /> EH Specialist: Phone: <br /> J <br /> Time in: Time Out: Page of <br /> EHD 1624 (20pg) 4/3/13 C'FOOD PROGRAM ORCONTINUATION <br /> J� <br /> / .S0 (Pr <br />