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Pa"'" SAN JOAGQUIN COUNTY <br /> �o.�.coG <br /> Q' ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • �q...y ,..;P• Telephone:(2Q9) 468-3420 Fax:(209) 464-0138 Web:www.segov.org/ehd <br /> FORa <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Lo 7 #n 0 t Date://_ ;3 <br /> Address: fi .� City: Zip Code: 2tZ�J <br /> Lam- C� .rte b <br /> Owner/Operator: Telephone: <br /> Program Element: _, ' Program Record: d. J Inspection Type: <br /> SS180 Posted No Permit Posted �Y ) No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> C <br /> Item/Location Temperature hem!Location <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: of Chlorine: ppm Heat: 'F <br /> Exp.Date: Warewashing Sink: of uat.Amm.: ppm Other: of <br /> Received By/Title: <br /> EH Specialist: rPhone: <br /> Time in: Time Out: Page `of l <br /> EHD 16.24 (2"d pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br /> J <br />