Laserfiche WebLink
aa�Aul" SAN JOAQUIN COUPv <br /> c'Oc <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • ���rFtSHd�P.� Telephone:(209) 468-3420 Fax:(209)464-0138 Web:www.siaoy.ong/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: /f ` ' Date: / <br /> Address: / City: Zip Code: <br /> wner/operator: Telephone: <br /> Program Element: � Program Record: 77--9`007 Inspection Type' - <br /> SB180 Posted Yes No Per Posted Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> / — y/ <br /> r � <br /> — <br /> ItemlLocation <br /> - Food Safety Certificatio > Facility of wafer 7emperatuf ng`= .. <br /> Name: // Hand Sink: TUU >FQuat <br /> Chlorine: m eat: F <br /> Exp.Date: �� arewashmgS1U oAmm.: PPMther: of <br /> Received By/Title: J 6bL <br /> EH Specialist: LZ PhogE:q f� <br /> ime in: Time Out:/ LPg ,of <br /> EHD 1824 (2n°pg) 4013 FOOD PROGRAM OR CONTINUATION <br />