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SAN JOAQUIN COUNTY <br /> �+ ENVIRONMENTAL HEALTH DEPARTMENT <br /> N: X <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • �q.. �;;P• Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.smgov.org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: LA Date: <br /> Address: oo City: Zip Code: qKJASN <br /> Owner/Operator: + a',(' t-Telephone: b — 3S <br /> �T�- <br /> Program Element: / Program Record: Inspection Type: <br /> SB180 Posted Ye No Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> SzwrCa, s ac s s <br /> ,e <br /> vn s� 17s�� <br /> On A 00 <br /> k-A agjez&ot: z &-J-- <br /> r f <br /> Item/Location Temperature Item/Location Temperature <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: of Chlorine: ppm Heat: of <br /> Exp.Date: arewashing Sink: of Ouat.Amm.: ppm Other: of <br /> Received By/Title: �t <br /> EH Specialist: ga Phone: <br /> Time in: V Time Out: Page/of <br /> EHD 16-24 (2n'pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />