Laserfiche WebLink
ot+ASlyc SAN JOAQUIN COUNTY <br /> z� ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • c4..,y ,.�;a• Telephone:(209)468-3420 Fax.,(209)464-0138 Web:www.sioov.org/ehd <br /> 4IFOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: C1 -b-) <br /> Address: 214 City: zip code: q 5 33p <br /> Owner/Operator: MircA-ni k('Q Telephone: 9U ,-Ct2bZ <br /> Program Element: \b2`l Program Record: zko� SS Inspection Type: •'t5 i <br /> B180 Posted Yes No �1 Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> t� L <br /> G <br /> $ 3 s5 me.Jl <br /> E\ �, <br /> r <br /> J <br /> S � -:1-9 tibl <br /> Item/Location '' Temperature Item Location .':Temperature <br /> i <br /> 7 111 <br /> i <br /> -ertmcation 'Facility Hot Water Temperature-. Waiewasfiing <br /> Name: Hand Sink: F Chlorine: PPM Heat: F <br /> Exp.Date: Warewashing Sink: =F uat.Amm.: PPM Other: F <br /> I <br /> eceived By/Title: 1tfH Specialist: - Y Phone:IS <br /> , 1 <br /> ime in: 1 O�• C Time Out: ) i <br /> O LPage 'of <br /> EHD 1624 (2�pg) 4/3'13 J FOOD PROGRAM OIR CONTINUATION <br />