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aPq�l" s SAN JOAQUIN COUNT <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.sggov.org/ehd <br /> 41FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: <br /> Lt� �l <br /> Address: O City: 22 Zip Code: <br /> Owner/Operator: /"� Telephone: <br /> Program Element: C Program ecord: /7 C Inspection Type: <br /> SB180 Posted Yes No Permit Posted Yes No G Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTION <br /> 7- <br /> Food <br /> Food Safety Certification PaUH.tperaturarm .... ". Warewashing <br /> Name: Hand Sink: F Chlorine: Ppm Heat: 'F <br /> Exp.Date: arewashing Sink: - 'F uat.Amm.: PPM (Other: "F <br /> Received By/Title-777 <br /> y/Title: 7 - <br /> EH Specialist: _ Phone• <br /> Time in: - �O •\S� Time Out: / / Page of <br /> EHD 16-24 (2-Pg) 4/3/13 FOOD PROGRAM OR CONTINUATION <br />