Laserfiche WebLink
o4s"'"•F SAN JOAQUIN COUNTY <br /> ?i ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> •.. ;P Telephone: (209)468-3420 Fax: (209)464-0138 Web:www.siciov.org/ehd <br /> ,�fFO'M1� <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: —� �' Date• 1% <br /> Address: City: Zip Code:�s3 <br /> i <br /> Owner/Operator: Telephone: <br /> Program Element: /�g Pr gram Record: iv 3 O Inspection Type: <br /> _ - i <br /> SB180 Posted Yes ❑ No Permit Posted ❑Yes D No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS v4 <br /> } >e" <br /> c <br /> Name: ^ Hand Sink: / � .F hforine: Ppm eat: 'F <br /> Exp.Date: arewashing Sink: .F uat.Amm.y«� Ppm ther: .F <br /> Received By I Title: <br /> EH Specialist: �¢ Phone: Oma. <br /> Time in: I Time Out: /a _ Page of <br /> i <br /> EHD 1624(2-pg)413113 FOOD PROGRAM OR CONTINUATION <br />