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gP•441n•.P SAN JOAQUIN COUNTY <br />' ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />c4crPdR�'p Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.s'.0 org/ehd <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />Name of Facility: Y <br />Date: 1-3-2-3 <br />Address: .Z3 2 <br />City: 11404 <br />Lh�eC� Zip Code: <br />Owner/Operator: / / <br />9 <br />.'r , <br />Telephone: <br />Program Element: <br />Program Record: - L <br />Inspection Type: <br />SB180 Posted Yes NO <br />Permit Posted Yes No <br />Re -Inspection on or After: <br />.- <br />i <br />AA7 i/. <br />RRECTIVE ACTIONS <br />gk� �,_ - <br />Itemlt.ocatioW <br />jEemperature <br />s <br />„ �6Food Safety Certificat177ran�da_Slnk; <br />fro <br />cility Hot Water Temperature <br />Name: ,1 <br />oP <br />Chlorine: Ppm Heat: >F <br />Exp. Date: <br />arewashin Sink: 1 <br />of <br />uat. Amm.: Ppm thear�: >F <br />Received By/ Title:kq'tal <br />S D _ 36 < (� <br />EH Specialist:r?jLZP' <br />Phone: 2 ©9 - 6'141 -- Sas Z <br />Time in: J / , Z <br />qM <br />Time Out: n14 Page of <br />EHD 16-24 (2ntl pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />