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SAN JOAQUIN COUNTY <br /> p .. <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> �q•. iP Telephone: (209) 468-3420 Fax: (209) 464-0138 Web:www.sigov.org/ehd <br /> �1FOFt t� <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: <br /> Address: Z LoCity: Zip Code: <br /> Owner/Operator: LA 0 I _ �. �� Telephone: `-=i <br /> Program Element: !• :� Program Record: L> - - -3 Inspection Type: - !� <br /> i l <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> Cu - �,�..�— -z�c;. {-�.s ' C�;-., �3 - /u -• ! �( � �j Lctvy� �=� c.c� c�c�c6� _ <br /> 0 Sa r rr L l-Gl i.Jt dl u-� <br /> Mclt 'C,f . A�t IS • C' ,i (, C,&4_4 <br /> - "j ,e Se (Ar <br /> f- <br /> Item/Location Temperature Item/Location Temperature <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: of Chlorine: ppm 11 Heat: of <br /> Exp.Date: Warewashing Sink: of Quat.Amm.: ppm Other: of <br /> 1 7 Received By/Title: <br /> EH Specialist: \ A Phone: (oLi yQ:;__ <br /> Time in: I C) Time Out: r y U Page iof 1 <br /> EHD 16-24 (2n°pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />