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SAN .JOAQUIN COUNTY <br />a <br />' ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />•.�4<]Ftsn�;� • Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.siaov.oro/ehd <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />Name of Facility: L1 <br />u <br />Date: <br />Uza <br />Address: "� <br />/ City: <br />v, <br />j / <br />Zip Code: <br />Owner/Operator:l <br />�J i Jw- <br />!/�" <br />Telephone: <br />Program Element: <br />Program Record: O P1 iC 1 If <br />Inspection Type: <br />B180 Posted Yes No <br />Permit Posted Yes No <br />Re -Inspection on or After: <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />t <br />- <br />r <br />ItemlL'dcation <br />- :emPerature <br />Item (Location <br />- - Temperature <br />Food Safety Certification <br />-.-_._ <br />Facility Hot Water Temperature <br />_ <br />_ _Warewashing <br />_ <br />Name: <br />Hand Sink: <br />"F <br />Chlorine: <br />PPM <br />Heat: <br />`F <br />Exp. Date: <br />arewashing Sink: <br />"F <br />uat. Amm.: <br />PPM <br />Other: <br />.F <br />Received By I Title: <br />EH Specialist: <br />Phone: <br />ime in: <br />Time Out: r <br />Page I of <br />EHD 1624 (2i°pg) 413113 FOOD PROGRAM OUR CONTINUATION <br />