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at``'i4''n'•s SAN JOAQUIN COUNTY <br />r ? ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />•"o... ;e• • Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.siaov.org/ehd <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />Name of Facility: <br />15I L-�> r, v <br />Date: <br />tldress: <br />City: <br />o Zip Code: <br />-Z 61S <br />Owner/Operator: <br />Telephone: <br />Program Element: <br />'L) Proglaim Record:l0 <br />/ .-7 <br />Inspection Type: <br />ih¢ <br />SBI SO Poste a <br />No Permit Posted; a No Re -Inspection on or After: <br />.AND CORRECTIVE ACTIO S <br />< s <br />; <br />C r i t �4 S • (s� <br />alt4" <br />JAI <br />rovi W <br />wd� <br />ol/ D t•• <br />Q b <br />f p (I ry < <br />p <br />1 <br />/ <br />r ray ^ <br />w <br />� P <br />O <br />A1 40 <br />✓ <br />If <br />Df- <br />q14 <br />�M <br />—( <br />Facility. Hot Water Te perature <br />Name: / i L - Hand Sink: , 'F IChlorine: <br />1/14 <br />ppm eat: <br />=F <br />Exp. Date: , U <br />_ of <br />IIZIL arewashing Sink: I -Z-5-T- <br />Ouat. Amm.: <br />ppm her. <br />=F <br />Received By / Title. <br />B Q <br />EH Speclalist: <br />N< j Phone: <br />Ime in: <br />vi Time Out:� <br />' - Z <br />Page o <br />EHD 1624 (2N pg) 413113 FOOD PROGRAM OIR CONTINUATION <br />