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�4"° roti SAN JOAQUIN COUNTY <br />' ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />�4 . „• , ••;a Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.siaov.ora/ehd <br />�IpdAt' <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />Name of Facility: L.r <br />Date: • 2 <br />Address: � `V� .l or�, City: <br />'?nZip Code: 5 P <br />Owner/Operator: /3� <br />Telephone: <br />Program Element:v�// Program Record: �C?176 `. <br />/ <br />Inspection Type: -0 yyG <br />v <br />58180 Poste No Permit Posted,,' -Yes No <br />Re -Inspection on or After: <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />1�1?oS�ilF ';r:;1F1C o N i 4�xJ UfVc rA�lc <br />�4-I✓� :� �'yrr� q <br />/ I V Ur/7 <br />�. <br />r <br />Y tl/L r <br />Item/Location <br />Temperature <br />Item / Location - <br />Temperature <br />Food Safety Certification <br />Facility Hot Water Temperature <br />Warewashing <br />Name: <br />Hand Sink: <br />,F <br />Chlorine: PPm <br />Heat: ,F <br />Exp. batel <br />arewashing Sink:of <br />IQuat. Amm.: PPm <br />Other; eF <br />Received By / Title: A0/06VI � •. /i:AA4A— Z <br />A006 <br />EH Specialist: /1 ' <br />/ <br />Phone: <br />Time in: IF <br />Time Out: 1 Page of <br />fL �4h <br />EHD 16-24 (20 pg) 413113 FOOD PROGRAM OIR CONTINUATION <br />