Laserfiche WebLink
�a� •cow SAN JOAQUIN COxy <br /> q ENVIRONMENTAL HEALTH DEPARTMENT <br /> _ 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax:(209)464-0138 Web:www•slgoy.org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: e Date: <br /> Address: <br /> City: Zip Code: <br /> Owner/Operator: Telephone: <br /> I <br /> Program Element: Program Record:V ' Inspection Type: <br /> ra <br /> P-180-Posted ❑Yes 11No Permit Posted ❑Yes ❑ No Re-Inspection on or After: <br /> n f! c &dclack <br /> t L - <br /> lR <br /> ji <br /> 9 <br /> 1 T <br /> h L / 44Z Vi <br /> tee, - <br /> &i, atO Ad <br /> V <br /> I <br /> ca (W 7 f t l 6acatioa. .. aTperatue' <br /> QfxdertrtrstErp ; <br /> .�€uire .=• � . <br /> Name: and Sink: 00 of hlorine: ppm Heat: of ' <br /> Exp,pate: arewashing Sink: of Quat.Amm.: ppm ther: of <br /> I <br /> eceived By/Title:H Specialist: f / Phone: L03 <br /> 2 2�L <br /> ime in: Time O t- f JJ'T Pag of <br /> EHD 16-24 (2n1 pg) 4!1/12 ; FOOD PROGRAM OIR CONTINUATION j <br /> 1 <br /> - - J <br />