Laserfiche WebLink
a�a fA SAN JOAQUIN COUI,.,I <br /> Q' `? ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax: (209)464-0138 Web:www.sioov.org/ehd <br /> 41FOk? <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date:Z/�5/1} <br /> ddress: City: Zip Code: <br /> b 1ll�coln <br /> Owner/Operator: Telephone: <br /> Program Element: 1 V p(, Program Record: CO oo Q Inspection Type: �M lciin <br /> B780 Posted Yes No Permit Posted Yes No Re-Inspection on or After: — <br /> CvM i s There wa u v1r2 a� It" <br /> pore waS CAAt wi Fine eftkW <br /> W <br /> -1lha,re �s no mo1-e dam ins�d►e The CW-A i <br /> -Thpr2 iS M s Sme %n lAxe, -Face t <br /> The -twx r S 6'111 in 00 'wcx-" <br /> Th?.r,2, i s no dar�a 't h¢ hoW by stw e e t <br /> �- a li is o tD .�rc�ke. ivdG <br /> a <br /> Name: Hand Sink: -F hlorine: PPM Heat: o f <br /> Exp.Date: arewashing Sink: of uat.Amm.: PPM ther: of <br /> ESialist: <br /> y I Title: ��,,//�� <br /> Phone: QADQ - IO� -3 <br /> � - Time Out: .. U rq PAjf <br /> EHD 1624 (T°pg) 4W3 FOOD PROGRAM OR CONTINUATION <br />