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SAN JOAQUIN CO' TY <br /> 4 ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.sigov.orq/ehd <br /> �IFOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: L1 ,� Date: <br /> Address: W!jy ,YY� Vim, City: Zip Code: <br /> Owner/Operator: ' � Telephone: <br /> Program Element: /n L{ Program Record:o i!� a fi Inspection Type: <br /> SB180 Posted Yes�f No/ Permit Posted Yetis�E No O Re-Inspection on or After: <br /> OBSERV IONS,AND CORRECTIVEACTIONS_ <br /> 44 u`� ov1 <br /> _ _ 16_ r ac <br /> 24 A <br /> .d <br /> _�l .�;4 -Y)--) <br /> fterii/Loeafinrr .` . =,Temperature lteM i Location Temperature <br /> -- ... — – - <br /> OW <br /> ........... <br /> Food Safety Certification Facility Hot Water Temperature Warewashmg <br /> Name: Hand Sink: 'F Chlorine �'L1 PPM IF <br /> Exp.Date: arewashing Sink: -F Ouat.Amm.: PPM Other: `F <br /> Received By/Title: <br /> EH Specialist: Phone: <br /> Time in: ? Time Out: T Pag f <br /> EHD 16-24 (2nd pg) 4/3!13 (/ FOOD PROGRAM OIR CONTINUATION <br />