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SAN JOAQUIN COUN <br /> ITF <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.si4ov.orp/ehd <br /> �iFORia <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: /, Date: _ <br /> Address: ��, D 9 City: �� Zip Code: 52� <br /> Owner/Operator: L r /.e r C. Telephone:-ID <br /> Program Element: /�O/ �! ProgramRecord: ` ` Inspection Type: na Gl <br /> SB180 Posted D Yes ❑ No Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> 0 <br /> Ll <br /> AU go 4-f 7 lia <br /> 1 [ o <br /> r Lu Iq ke r <br /> f-4AY r <br /> A)o 'aLL4w.e `lo hood otu'aa <br /> o-n f• 5 <br /> d - <br /> o � <br /> O — <br /> b O <br /> D <br /> alzw 4- P ; A—&-S OL <br /> t u GD C - <br /> Item/Location Temperature Item/Location Temperature Item/Location Temperature <br /> if&I YO <br /> Watlq - <br /> G <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: 1D9/ D� of Chlorine: ppm Heat: of <br /> Exp.Date: Warewashing Sink: 1/ of Quat. Amm.: ppm Other: of <br /> Received By/Title: <br /> EH Specialist: Phone: <br /> L / <br /> Time in: ._ Time Out: 2 ",50 Page of <br /> l <br /> EHD 16-24 (2^d pg) 1112/09 FOOD PROGRAM OR CONTINUATION <br />