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SAN JOAQUIN COUNTY <br />oP�.coG <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />Cq .. <br />p Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sigov.org/ehd <br />�I FORS <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />Name of Facility: LA- <br />ddress: <br />S� <br />.on City; S <br />Date: <br />Zlp Code: <br />- S"� fJ S <br />Owner/Operator: '70_ _ ' <br />— <br />Telephone: <br />Program Element: I N Program Record: 5 p6 o <br />Inspection Type: <br />µ _ <br />e No Permit <br />H180 Posted 4T5, <br />Posted Yes ' No Re -Inspection on or After: <br />-q�` <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />4161 <br />7,'A <br />Se s <br />7 <br />/o <br />Item/LoceItl2n. <br />Temperature <br />Item / Location <br />Temperature <br />Cod Sa=1oationFacility <br />Date:areweshing <br />HotWater Tempame:Hand Sink: F Chlorine: <br />Sink: aF Quat. Amm.: <br />PPM <br />PPM ther: <br />FFExp. <br />°F <br />itle: y,/ <br />v <br />FSpecialist:%PL <br />7) U <br />_ Phone: <br />Time Out: <br />I 3 Page of <br />"L conn eenroAKA No PAKITIM]ATIM <br />EHD13-24 (2 -pg) 4013 <br />