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SAN JOAQUIN COUN . <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East HazeIton Avenue, Stockton, CA 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.siciov.orq/ehd <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />Name of Facility: L.-.(\C-\(\ e• 1 k CA C-\00k \ <br />--4-t --4.F..7 ..,1 a Date: \ ----7._ ( -7 <br />Address: t i t ---1 U (‘....0sr.‘ ,s_\__ City: Zip Code: <br />Owner/Operator: G \ se° \_) iv\ 42,5k.An et . <br />Telephone: <br />Program Element: Program Record: Inspection Typec <br />SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br />U1/4./Jr- If"'s•r2 <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />S CO -78a.56 <br />N4 (N;2A./U (),)31--c. r \ov„,-(2 I >c ta3k-1,-, ,,-.P..9., <br />\),2_1—x Ix _ <br />ODAr„,v-, cki 10-‘.,.eA0-2,1- s4-\.(y?. ..res2)e._ <br />3) 2--gat - LS f----v-1- N-Q-,...Ni\--..-----Q_ Cb ko.,„-. / -,o— A4 <br />- ,_z,,....Q ,---2_6...,' tov II -3 I - ( -4_ 5p....-,-, <br />-c-.1._ 20‘ (5 \js, k\ 1--.0-* V1.12, k SS-96.1 L)r-11-1 <br />\C'ed -AN. cr-21----- r..-TV71C ,A.' I e_ce D t7"4- _ <br />Item/Location Temperature Item / Location Temperature <br />ACTh, ---;,f ts.- F <br />iSth-- <br />c-I-Sli- 3--4-1-21 <br />1 /4-k?1F <br />Food Safety Certification Facility Hot Water Temperature 1 Warewashing <br />Name: v <br />t---\- \• ',,,: s ---..Ski\e 1 Hand Sink: \-3c . 0F Chlorine: PPm Heat: . <br />Warewashing Sink: k 0 uat. Amm.: PPm Other: . Exp. Date: ---/ - 2- \•4 - 2-Ci <br />Received By / Title: j\ CA-0--- i\NcLcK%'\C ______ <br />EH Specialist:Phone: Libq .....033,(:)... <br />Time in: Time Out: Page of <br />OQYY-N t I <br />EHD 16-24 (2^d pg) 4/3/13