Laserfiche WebLink
°9!N..C' SAN JOAQUIN COUN <br /> N: X <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • �q... �;;P• Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.sagov.org/ehd <br /> <<FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: - Date: <br /> Address: City: —r Zip Code: �a <br /> .� � ? �--• � I 'l �.4- a'to 2" % �S-.� :�.L <br /> Owner/Operator: Telephone: <br /> Program Element: Program Record: Inspection Type: <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> y <br /> x <br /> (� / ;SSo6/ { ctSn Ca7n I 1k rPv C G c,n h[ <br /> i �0Of, i E a A r 0 l IL ;G11AGl v hr,' <br /> 1Cj W 6 i%e on 4. n i,ed D o n9, Cc, r3 W . IhCN <br /> (i1S h; r\ C. CC tArrc �Pr WC, h AGAd C; <br /> Ilya s ltr <br /> AA� �o <br /> 1 OC �a fA <br /> Y 2r, ls ( C1¢ � l� r yr Ser✓� r• ariC, <br /> Ke to Ve r,tt h/ ''/' <br /> S Zr✓ : n fr S fa It Gr intI CA "� e <br /> 5 � I Sr a. rrtc4-CJ <br /> WrAr .r. <br /> 7u - •r <br /> IfO �r�, o�, I.F �(Ar/�'1Cr- 13S' 170 F 77 C J <br /> salod Gt:S fu . ! tfi0if 82 C I <br /> 1 ra U 5 0 LL)01 I "- ) l3S 1' j;an Is��,. /�? oar Fl l= <br /> 1 Y <br /> _^r -don A )'F 2-docs • irn 1 <br /> 015rr-, I -d0vr '1 / GrrY►( r /3S � <br /> Name: Hand Sink: ° Chlorine: Heat: <br /> Cr, rf� L �G n a S F ppm o 107 <br /> °F <br /> Exp.Date: '✓ y arewashing Sink: °F Quat.Amm.: v ppm Other: °F <br /> Received By/Title: <br /> EH Specialist: Phone: , <br /> Time in: Time Out: © Pages of 2 <br /> EHD 16-24 (2,d pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />