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a"•�•. SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> •. ;a+ Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.sjgov.ora/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: LO, G\ A TW -S` ��� Date: <br /> Address: \-+ 5. City: Zip Code: p1 •S2� <br /> Owner/Operator: Telephone: <br /> Program Element: 1 C Program Record: Inspection Type: <br /> B180 Posted Yes No J Permit Posted Yes No Re-Inspection on or After: <br /> OBS j O R 1gE ACTIONS <br /> Z — Gh <br /> Li. --tV- S SZbS <br /> 42 <br /> A2 e <br /> e C fv_^4� <br /> S <br /> J- <br /> A- <br /> IN <br /> o� \ <br /> 2 { e <br /> - ( tsJLocationAM IIIIIIIIEWture <br /> 2 <br /> llr <br /> fefy Certification Facility Hot Water Temperature " <br /> Name: - J C \\Q Hand Sink: �W oR Chlorine: PPM Heat: of <br /> Exp.De e: 3_ 1 S_ 2 arewashing Sink: ` l 'F Ouat.Amm.: PPM then. o f <br /> Eln: <br /> tle: <br /> Phone: 2 _S Time Out: �t 1 _ V Pagel of <br /> EHD 1&24 (2m pg) 4/T13 �O FOOD PROGRAM OIR CONTINUATION <br />