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oSAN JOAQUIN COUNTY <br /> a ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-5232 <br /> Telephone:(209) 468-3420 Fax. (209) 464-0138 Web:wwvj.siciov.orglehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Lr S Date: 79 4 <br /> Address: l 14 r4. <br /> • 1,1 Y q)1 ' wo u City: -:VC,ot_.l U Zip Code: CT%o <br /> Owner/Operator: �U'4M C „V aJ Telephone: ll <br /> Program Element: (� Program Record: �• C) 2 Inspection Type: (U�� �1 <br /> SB180 Posted Yes No Permit Posted Yes No J� Re-Inspection on or After: 9 {r <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> � ► - 4 U fiU svhu � ` off ; _ Q na+i- <br /> 1 )R�' dee fffNCkVCkd CJf 1�V f t� 1fi� O <br /> -- C) i c1 n0- cA> v� Caz�S v i� me c� f 11�S�Jo_ <br /> -frac,I I tq <br /> f <br /> Itern/Gcation Temperature Item 1 Location Temperature <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Nance: /! Hand Sink: `F Chlorine: ppm Heat: qF <br /> Exp.Date: �/ Warewashing Sink: "F Quat.Amm.: ppm Other: aF <br /> Received By/Title: <br /> EH Specialist: Phone: (e� <br /> 1 � <br /> Time in: ` "+S Time Out: Pae of <br /> END 1624 (2nd pg) 46113 FOOD PROGRAM OIR CONTINUATION <br />