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SAN JOAQUIN COU Y <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax:(209)464-0138 Web:www.siclov.or /q ehd <br /> t�FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: r_ <br /> Address: `lam-D 1 A ren G+ City: �CAG Zip Code: 9 6.�7 <br /> Owner/Operator: L h-� C414 q i2i <br /> Telephone: -i�555 Z <br /> Program Element: 105 S Program Record:i 100 Z Inspection Type: <br /> SB 180 Posted .Yes No Permit Posted QYes No Re-Inspection on or After: i1 <br /> C?BSERVAT1ON$AND CORRECTIVE ACTlC3N5 a <br /> .1 _ [° 5-t-n t'>�r et Y- — � e Gi r e Yt'�•t_C ........... .... <br /> _ M_. . _�-r�o. I-r� Imo........... . ......... ----. <br /> - c <br /> 1-�-�.,--1 ___� __mss-�-__��-� � u7 <br /> a.4- 3-C-0 r►ti 51 till- c.1 r.2r,Z <br /> o Y,, Yo -a- CU r r►�w� <br /> !'I S <br /> ...... + .................. <br /> Q � l,t� <br /> rzka rrn t P ro ' 1-GL 'I ct r�-e_c... ___7F_o r <br /> ._.!'!'1/L.._. 5. •..__... ��. (.....:`-�,........ X5...1"1 P.tc. .. .........l S._� - .. ......._... . ...CL0_0 "'7 U1 ✓t-� -- <br /> - -1-� ��c�l awl- a�(.l -�-� r�-�� rY E- L� 15 <br /> Mod" ✓ c �1� r>tio_c c�. _ .._._._ a_n_... __.._�►__ dC 5 a ti%t-f; <br /> Irl u4-i ac r S-c7 rn 66.&f s 6.1-n <br /> r ZoD rs vie tLe�� 17 f A- I <br /> - c -e ---- ,�----5- to Q <br /> .. `ItemJt octi s Tem erature <br /> x _ . P -_-Men ;Location .- fQrriperature <br /> Mv- Ll ('ice <br /> rn.eV S 34 Z CA-00 Y'_ `i—Y-u 3 8r <br /> Food'Sail" <br /> e Y� t " HotYVaterTemperature " 1Narewashing <br /> Name: Hand Sink: 2 3 Chlorn Heat: <br /> �- °F in O-4(A L4m `F <br /> Exp.Date: Ware ashing Sink: ii Z-7 of Quat.Amm.: ppm Other: aF <br /> Received By!Title: IG <br /> EH Specialist: . U/ Phone: <br /> Time in: / "al 5 Time Out: 26Page f 2 <br /> EHD 16-24 (2-pg) 4/3113 FOOD PROGRAM OIR CONTINUATION <br />