Laserfiche WebLink
ana41N• <br /> SAN JOAOIIIN COUIj <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.siaoy.ora/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: I <br /> Address: .2-15 <br /> i Mail `loCity: Zip Code: S>YL <br /> Owner/Operator: t Telephone: �Y <br /> Program Element: I`6 Program Record: 01/ .� Inspection Type: J <br /> �o h <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> BSERVA <br /> GLOM l'N� A3S i3 IA.Y- /9uCET L�<E—TTS f ��JJ/LL<C�P70iLJ <br /> P.,rl°igl2 SToP /9J.L (,.,,Lf9K5 rffiv� � /'s ru��D/ri/�`ct. , <br /> CGo //U.0 kit 3��PSry S /7E Rt5 �wl� N /n-i L � <br /> Q47b�fti+t 7Dr Fv— Fjqf'(C-K 15 ,B o A) PRoU/ 6t <br /> /t.LC-•,7 r9 �e c�8? /�rpt�s ,ct,C�.4'�rav /s��ved�97�c <br /> ll�Nlti n1 6 H/4 D T/fE /eE Mi3KFR , FPAI P�/�K B <br /> 3 13/� T TIfE 1��4Nb SANK hk+u�it 7/Fr5 <br /> AS Ax-t rc 2 Wj9h o-r /000 Ron& A9 A`1 ki vG <br /> UHUJE /5 re Co?QEeT -/� l <br /> _iVV <br /> Facility H <br /> Name: and Sink: -F hlorine: ppm eat: eF <br /> Exp.Date: arewashing Sink: <br /> 'F rust.Amm.: ppm r <br /> ther: =F <br /> Received By/Title: 77 <br /> EH Specialist: Phone. 1' - 2 1 rIT' <br /> Time in: t•y- 30 Time Out: 11X_11X_ J Page Zot L <br /> EHD 1624 (2-pg) 1112M FOOD PROGRAM OIR CONTINUATION <br />