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a11" SAN JOAQUIN COU <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> �q.... .•.�;;P Telephone:(209) 468-3420 Fax:(209)464-0138 Web:www.sigov.orp/ehd <br /> LIFOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: LA <br /> n) <br /> rsi ,n�Y— Date: !_ <br /> Address: O 1 r� �� �r Cit -foZip Code: <br /> Owner/Operator: '130 n P'P •i Telephone: (460-5,?9(0 <br /> LIP Program Element: I.-LLv Program Record: P �0 52g2 Inspection Type:%v..H me— <br /> SB180 Posted es No Permit Posted Yes No Re-Inspection on or After: <br /> QS <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> _� `T)'l.g-,. a---a90 ll'�T_r_vt-f- Goo ct Y, .I `h+ -r nd - htx+ hart CA SiA _. <br /> nA=5h I'1'lGc�tn �vf a aLIF ar LoV.-e r _-- <br /> .. t. _....__-e s ...----r-�r-e n-04 -- L-d_ -e._ I a t_ 14_d d n-i o re <br /> lea (7..( ✓► ...- - _...- ---- <br /> �� <br /> --a4-. -44 Y-..............p.._r.......... <br /> ........... .. ._vc�e.r._...... ._...._............_...................................... --— <br /> IF Le- <br /> �►' Gu t,-, a Yom, Was ryw <br /> S ' <br /> ,s 'ldo r 5 Ct>le- absor 3a-ern+ . I - -e b <br /> c <br /> Y— rYLea so r 1' Cev S -e ak <br /> U i-u2 a Mj --e- LA.A rr,.e n <br /> 1C �zl. _........__Ol_Y`Q ___�_►'1,�__c�J rte►_ <br /> .._...... ......._....d•r ._ - _r ._..._.- �s+V r-e -Foo <br /> ��►-, sS-e�t lit�l 04 h Lac. h.e." 5 - -p-e o" 4--> <br /> 4AA r&CXS LQh sW.-k nsI)5 h V.-e.............. 5.......... <br /> b - ") <br /> Y <br /> Z W-A• _ <br /> (YLea t � .kms 3 SPro axAo <br /> It81Yf/L OCitj{SCk ,..,z. ,, THY <br /> _tt@m/L.00atlOrl.,,.xof w-eV-% - ry1�'+ bar-o >-v Tru ___. A81?--7 <br /> Li <br /> T Q <br /> -' '+ <br /> Fo1�ti fetyrtlfiCt9n "� act Hot W�ter: sm rature, ��� .s erewashing . .. d <br /> Name Hand Sink: ox Chlorine: Hat: <br /> h" Lzs v-e ri �l y F ppm F <br /> Exp.Da e: � �� a a 'ng Si -F JjXt.Amm.: Oppm O � "i <br /> Received By/Title: <br /> • tr. <br /> EH Specialist: - /. _ _ Phone: <br /> Time in: I Time Out: Lib <br /> b Pageef 5 <br /> EHD 1&24 (2n°pg) 413113 " FOOD PROGRAM OIR CONTINUATION <br />