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o. C <br /> "g"I" SAN JOAQUIN COUN' <br /> Q` ya ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.s'gov.org/ehd <br /> LikoR`' <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: T Date: cg—S— <br /> Address: 39City: ` zip Code: S <br /> Owner/Operator: /V(aN Telephone: <br /> Program Element: /6 Program ord: O I LC) 21 Inspection Type: <br /> 2'45SB180 Postedxyes No Permit Posted ayes No Re-Inspection on or After: <br /> nse 01 <br /> tXj Ck 4e r- <br /> C$ e <br /> cl 4 <br /> It _ Temperature `!tem/Location Temperature <br /> O'r l b I <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: v,i Hand Sink: ® � of Chlorine: ppm Heat: of <br /> Exp. Date: - Z D arewashing Sink: of Quat.Amm.: Ppm 11 Other: of <br /> Received By/Title: �+ 1_ <br /> EH Specialist: l� Phone: <br /> Time in: `D � O Time Out: Yui PagdpofZ <br /> EHD 16-24 (2^d pg) 4/3/13 , FOOD PROGRAM OIR CONTINUATION <br />