Laserfiche WebLink
SAN JOAOUIN COUF <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • ... ;P• Telephone:(209) 468-3420 Fax:(209)464-0138 Web:www.si.ov.org/ehd <br /> 4c,FOAa <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: <br /> Address: City: Zip Code: <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 /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> --------..-...._._.......................................... <br /> . <br /> ........._.._....,. ................._...._ _!o.GiY.I,�/'l —�.l <br /> Item/Location Item l Location <br /> _ ... _ <br /> Food Safety Certification FaciJrty Hat Water Temperature 1Narewashing <br /> – <br /> Name: Hand Sink: °F Chlorine: ppm Heat: -F <br /> Exp.Date: Warewashing Sink: -F Ouat.Amm.: ppm Other: of <br /> Received itle: <br /> EH Sp ialist: Phone: <br /> ime in. i Time Out: Page f <br /> EHD 16.24 (2n1 pg) 4/3113 FOOD PROGRAM OIR CONTINUATION <br />