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SAN JOAQUIN COUN' <br />P. <br />�O. •T� .coG <br />Z� ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.slgov.org/ehd <br />�/FOR <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />Name of Facility: <br />3 L C <br />Date: <br />Sy S" /S <br />ddress: <br />] i i� City: <br />1 (N <br />Zip Code: <br />Owner/Operator: <br />Telephone: <br />Q �1 <br />Program Element: <br />Program Record: 7 -7-0 <br />Inspection Type: <br />B180 Posted <br />Yes ❑ Rermit Posted Yes ❑ I <br />Re -Inspection on or After: <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />11) D )W4�A rr Odd- ave ay_� Zh, I-V,- n W r,4 <br />- <br />Emu== tigft — h <br />Item/Location Temora .. re Ite acation Temperature <br />b <br />}y y a -nature Vi►arQw \ <br />aot a e Certification i Facilit Hoti afer f I __. ashing <br />Name: <br />� +� Hand Sink: of Chlorine: ppm Heat: of <br />Exp. Date: arewashing Sink:\ I- i of uat. Amm.: ppm Cher: of <br />III I <br />Received l3v / Title: \ <br />Itn bpeciaust: IJ/l ,(�'UV�/ (. I Ly Phone: L140 <br />J , / dj/ I <br />Time in: / r� t( - -► - V Time Out: Pagerof, ,Z <br />EHD 16-24 (211 pg) 4,13/13 FOOD PROGRAM OIR CONTINUATION <br />