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aP""i"•g SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />odiiFdai+" Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sigov.org/ehd <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />Name of Facility: <br />L ( W 14 <br />1 C <br />Date: <br />.Z <br />Address: <br />CI <br />Zip Code: <br />Owner/Operator: <br />Telephone: <br />Program Element: <br />6180 Posted Yes <br />Program Record: <br />No Permit Posted Yes No <br />Inspection Type: <br />Re -Inspection on or After: <br />D <br />SERVATIONS AND CORRECT!, ACTIONS <br />go L -6 ✓ J D <br />7~7 <br />/ <br />5L ­`F O Z,v <br />Orq CF <br />� S <br />EC <br />s <br />Item/Location <br />Tem rature <br />p¢ <br />J <br />tem / Location <br />'- em ifilre <br />Food Safety Certification <br />Name: <br />Facility Hot Water Temperature._ <br />Hand Sink: <br />- Warewashin - <br />'F Chlorine: PPM Heat: <br />-F <br />Exp. Date <br />arewashing Sink: <br />of uat. Amm.: PPM <br />Other: <br />=F <br />Received By/ Title: <br />EH Specialist: <br />- Aq d1 <br />c <br />/7-7 u <br />Phone: <br />ime in: <br />O <br />Time Out: 8; 3 g !lA1 <br />Peg e of <br />EHD 16-24 (V pg) 413/13 FOOD PROGRAM OR CONTINUATION <br />