Laserfiche WebLink
SAN JOAQUIN COUN . <br /> _ ? ENVIRONMENTAL HEALTH DEPARTMENT <br /> UPi' a <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> cq P Telephone: (209) 468-3420 Fax: (209)464-0138 Web:www.sigov.org/ehd <br /> �iFOR� <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: <br /> Address: v City: c Zip Code: <br /> perator: J Telephone: <br /> Program Element: �/ 1 Program Record: Inspection Type: W- <br /> Owner/O <br /> SB180 Posted ❑Yes ❑ Rermit Posted ❑Yesti� 1 Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> r <br /> / t <br /> 6tcl 10 -3 <br /> t2 Q 77-h <br /> s <br /> 1 <br /> 1 <br /> F J <br /> r ^ � <br /> � � _ <br /> ure �" Item/Location Temperature <br /> OR lid <br /> Food Safety Certification FacilityNot Water Temperature _ Warewashing <br /> Name: - Hand Sink: - of Chlorine: ppm Heat: of <br /> Exp.Date: arewashing Sink: of Quat.Amm.: ppm Other: F <br /> Received By/Title: s �,C <br /> EH Specialist: <br /> ime in: Z Time Out: L422S Page of <br /> EHD 1624 (2n°pg) 4/3113 <br /> FOOD PROGRAM OIR CONTINUATION <br />