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oPagln• SAN JOAQUIN COUNTY <br /> 1�tea• 06 <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> qcl. dAar Telephone:(209) 468-3420 Fax:(209)464-0138 Web:www.siaov.oralehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: LF' _n - Date: — c1/.._ �. <br /> Address: W. saf4pmA Avechy: <br /> n9c Zip Code: <br /> Owner/Operator: L GC40 Telephone: <br /> 17-F <br /> Program Element: Programcord: •' Inspection Type: g�� <br /> sB1 BO Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> 4 )eC) < LI t' . <br /> I/ r <br /> Item/Location Temperature Item l Location .Temperature <br /> Food Safety Certification 0111ty Hot.Water Temperature Werewashing <br /> Name: Hand Sink: "F Chlorine: ppm Heat: "F <br /> Exp.Date: /" arewashing Sink: F Quat. Amm.: ppm Other: 'F <br /> LHSpeclallst: <br /> By/Titie: <br /> t Phone: z Time Out: Page of <br /> EH 16-24 (2"pg) 4/3113 FOOD PROGRAM OIR CONTINUATION <br />