Laserfiche WebLink
SAN JOAQUIN COU', ' <br /> 4 a ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.sigov.org/ehd <br /> CjFO'R� <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: !� �, Zt j Date: <br /> Address: C1/ 7 City: Zip Code: <br /> at <br /> Owner/Operor: N^ ('VA' n Telephone: <br /> Program Element: i Program Record:l) r-/ Inspection Type: fly <br /> SB180 Postedxk <br /> Yes No Permit Posted Yes No Re-Inspection on or After: <br /> i <br /> OBSERVATIONS AND CORRECTIVE ACTIONS. <br /> Z4 ............ - - -- - <br /> w� <br /> V-4 G'(,� ✓�-r vt�c yr <br /> Item/Location j Temperature Item i Location j Temperature <br /> .c.L v <br /> ✓L i/l <br /> Food Safety Certification Facility Hot Water Temperature ! warewashing <br /> Name: Hand Sink: �F Chlorine: ppm Heat: �F <br /> Exp.Date: Warewashing Sink: of Quat.Amm.: ppm Other: 'F <br /> Received By/Title: <br /> EH Specialist: Vrx <br /> Phone: / <br /> Time in: / '. Time Out: 0 Pagof <br /> EHD 1624 (2nd pg)4/3113 FOOD PROGRAM 01R CONTINUATION <br />