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O <br /> SAN JOAQUIN COUNT <br /> �a ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> •.. ;P Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.s'gov.org/ehd <br /> 4�i)ib t� <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: L�_­ s s G k Date: <br /> Address: / 51� City: Zip Code: <br /> Owner/Operator: T Telephone: <br /> Program Element: `� I Program Record: p I�r Inspection Type: - <br /> SB180 Posted Yes o P 1tPosted Yes -/-No Re-Inspection on or After: K(� <br /> OBSERVATIONS AND,CORRECTIVE ACTIONS <br /> u - - ;S h0+ <br /> uj 0,0,r -CA no+ C' M -1-0 0 -�) 5 f-e_�-f- <br /> +0 U 64eL 0. T d, d "U_/ <br /> 6 n �� X. 11 Zo is ( n e- w mev -eme <br /> ` r <br /> w clos -� r n-E-'_( <br /> - +t-I k d 3 <br /> r in - <br /> h r fits o _ <br /> a 2sf-r�or� 30 <br /> 3 U5 l�v t V n ✓t s d C)C44—' ' <br /> s <br /> a) � - o <br /> item/Location Temperature Item!Locafion Temperature Item/Location Temperature <br /> - <br /> 2 <br /> 1 <br /> 00 <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: 7 Hand Sink: 103 <br /> 'F_Chlorine: _ ppm Heat: of <br /> Exp.Date: arewashing Sink: 'F Quat.Amktm.: 00 ppm Other: °F <br /> Received By/Title: <br /> EH Specialist: Phone: <br /> Time in: Time Out: Page of <br /> EHD 16-24 (2"d pg) 11/2/09 FOOD PROGRAM OIR CONTINUATION <br />