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PQ"'. SAN JOAQUIN COUNTY <br /> ,o.glfv <br /> y� ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> . �q.. .�;;P. Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.sigov.org/ehd <br /> ��FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: L')Ck'� jFi � Date: f/ a <br /> Address: Z Cj eL b,� D� City: 5T'j e ,` �,� ( Zip Code: <br /> Owner/Operator: 1 Telephone: <br /> Program Element: Program Record: G G� �r �„ ,` Inspection Type: <br /> SB180 Posted Yes N Permit Posted Yes ` o J Re-Inspection on or After: I6 <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> a i L/ C- 17 tiC-e <br /> flil r T • <br /> WNW <br /> Item/l ocation Temperature <br /> — f <br /> Food Safe Certification Facilit Hot Water Tem era#ure Warewasfiing <br /> Safety Y P <br /> Name: Hand Sink: `F Chlorine: ppm Heat: of <br /> Exp.Date: Warewashing Sink: of Quat.Amm.: ppm Other: of <br /> Received By/Title (� - <br /> EH Specialist: Phone: <br /> Time in: Time Out: Page of <br /> EHD 16-24 (2ntl pg) 4/3/13 FOOD PROGRAM OR CONTINUATION <br /> r <br /> .J <br />