Laserfiche WebLink
i <br /> a <br /> SAN JOAQUIN COON' <br /> �.••�a••.oma I <br /> a ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 ' <br /> • gid.., •..•;P• Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.sigov.org/ehd <br /> 4rFouN <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: ' Date: <br /> Address: City: Zip Code: <br /> Owner/Operator: Telephone: <br /> I <br /> Program Element: Program Record: Inspection Type: i <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> i <br /> I <br /> OBSERVATIUNS ANQ CORRI=CTI1lE ACTIONS s <br /> aea <br /> i <br /> L I <br /> I <br /> t D <br /> 4 <br /> 1 <br /> i <br /> a .., ItemlLnca on ATeinperature,e„• tEem I t.ocafion$ eMperature: <br /> i <br /> Ft�pd�Safe Cert�fca#ion " Facih HotYl►aterTerpeeatur�, ;<- -, -.rte. Yyareiraash�ng ,° lip <br /> ty tY <br /> Name: Hand Sink: of Chlorine: ppm Heat: OF <br /> Exp.Date: Warewashing Sink: OF Quat.Amm.. ppm Other: of <br /> Received By f Title- <br /> EH Special i Phone• r7 <br /> Time in: Time Out: l' Pag of <br /> EHD 16-24 (2nd pg) 4!3113 FOOD PROGRAM OR CONTINUATION <br />