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SAN JOAQUIN COUNTY <br />`s ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sigov.org/ehd <br />4rFOA? <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />Name of Facility: L4-1 6-1 <br />6 V_0'- <br />Date: <br />0 Z <br />ddress: I.1 <br />_MW <br />PtlafA <br />City: <br />Zip Code: <br />caner/Operator: 1 .Ince <br />la �,Q <br />Telephone: <br />Program Element:l/ W 5- <br />> <br />Program Record: b loci <br />Inspection Type:'„ <br />B180 Posted Yes No <br />Permit Posted Yes No <br />Reinspection on or After: I <br />Z <br />y.b�3 <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />I(, s <br />,r <br />vi A <br />C'�✓'i1 f� Q <br />I S /R GI�In <br />r-OVIOU VA i <br />-C t- h <br />W l i <br />d <br />n <br />e <br />n <br />✓ ov CIA r <br />r<'t <br />V- <br />AG <br />"Q <br />Ivy f V r t <br />W i! <br />l U I H <br />O <br />OcwIr • <br />✓ ✓A <br />C49044 10 <br />e' 11 <br />F <br />— w aw, <br />w <br />/iv / <br />i C "t lif ov✓ <br />v'_ <br />f <br />� <br />.Food Safety Certi icatlon"��`" ;: Facility Hot water Temperature- <br />Name: Hand Sink: 'F Chlorine: <br />Exp. Date:arewashing Sink: 'F Oust. Amm.: <br />Warewashing <br />ppm (Heat: <br />ppm Other: <br />" <br />:F <br />"F <br />Received By/ Title: <br />H Specialist: i <br />Phone: <br />lX <br />Time in: t <br />Time Out: <br />Pag of Z <br />EHD 16-24 (2ntl pg) 4313 FOOD PROGRAM 018 CONTINUATION <br />