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SAN aJOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sigov.orq/ehd <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />Name of Facility: • " ( K <br />S 0 <br />Date: Z <br />zvz,3 <br />Address: S <br />L D � <br />City: Zip Code: <br />Owner/Operator: MAL <br />Telephone: <br />Program Element: <br />Program Record: O O v <br />Inspection Type nlkbkth <br />B180 Posted <br />0 Yes 0 Rermit Posted []Yes <br />0 1 Re -Inspection on or After: <br />ass aTt Ns: , p. cO c�rIV CT)ONS <br />i c_/t� L ac h "rh;,'�� <br />-- <br />w <br />i I ainw- <br />r <br />Sulnc <br />ow h vt. <br />r <br />tlOa IVI OtlS n ✓. <br />iLLG <br />G OVi 1 <br />6 1VVL <br />inpr� ✓ <br />VVWv`e -- <br />---4emiGocation Temperature <br />��x ���� <br />- - - LC,&�"t",40 <br />V <br />Item flotation <br />c-� �� V, <br />I ki )L-4,. - <br />' <br />3F <br />t� <br />v <br />L7< � -t ,� <br />rip tiny c "Ey <br />v� <br />✓1 <br />Name: Vn1I ✓I <br />PhaExp. Date: <br />Facility Hot Water Temperature <br />h -Hand Sink:- of <br />arewashing Sink: - -F <br />Warewashing <br />Chlorine: Ppm Heat: <br />- - - F <br />uaat1 Amm.: PPM <br />then. <br />"F <br />Received By I Title: <br />�i o T '� L S� U 1 <br />EH Specialist: _ .� ( <br />Phone: <br />Time in: ; u <br />Time Out: - <br />Pages X <br />EHD 1624 (2 pg) 413113 1 FOOD PROGRAM OR CONTINUATION <br />