Laserfiche WebLink
SAN JOAQUIN COUNT <br /> e: < <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax:(209)464-0138 Web:www.sigov.org/ehd <br /> 4rF0A� <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: <br /> Address: 2- — 12City: Zip Code: q Sz <br /> Owner/Operator: M Q f Ky,• , 5\ Telephone: S <br /> Program Element: , Program Record: O3-Z Inspection Type: <br /> SB180 Posted es No Permit Posted kXes J No Re-Inspection on or After: <br /> �- OBSERLAjl,ONS AND CQRRECTN_ TIONS <br /> � <br /> 12e _c\��� P c k-�of f✓�d.i s ren J, box�� cy-ry ld-, r <br /> \ J� <br /> GI 1 <br /> �© <br /> Food Safety Certification Fal cility Not Water Temperature ;'' Wprewashing <br /> Name .Hand Sink: `�,. `F Chlorine: PPM eat' F <br /> Exp.Date. rewashing Sink: 1-Z 'F Ouat Amm.: PPm er. jF <br /> Received By/Title: �; <br /> EH Specialist: ne. y b — <br /> ime in: I V. <br /> Ste— Time Out: 2 Page2of <br /> EHD 16-24 (2n°pg) 41313 FOOD PROGRAM OR CONTINUATION <br />