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SAN JOAQUIN COUNTY <br /> �+ ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> :P Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.s'gov.org/ehd <br /> 9�1Foa`' <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: LzD Date: <br /> Address: 2 City: Zip Code: <br /> Owner/Operator: N-VTelephone: / , p.,� <br /> Program Element: Program ecord: Z' Inspection Type: a� <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> Vl <br /> L <br /> 1 i l <br /> Pgwyr <br /> Item/Location•. Temperature Item!Location Temperature <br /> �D <br /> /7I <br /> ti <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: 00 of Chlorine: u0 ppm Heat of <br /> Exp.Date: Z� arewashing Sink. of Quat.Amm.: D ppm Other. s _ of <br /> Received By/Title: .S � I EA ra SI a <br /> xst7� gyp(; <br /> EH Specialist: Phone: COh <br /> Time in: Time Out: / Page. of <br /> EHD 16-24 (2n°pg) 413113 FOOD PROGRAM OR CONTINUATION <br />