Laserfiche WebLink
SAN JOAQUIN COUN'. <br />Q` ENVIRONMENTAL HEALTH DEPARTMENT <br />-_ 1868 East Hazelton Avenue, Stockton, CA 95205-6232 - <br />• cq.. �p • Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.s'gov.org/ehd <br />�/FORD <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />Name of Facilityr— `c -,C <br />� N\� (\ \ S k' e S Date: 0- -z Z - <br />Address: 3 & c'City: <br />L <br />C Zip Code: OI <br />—k (-C" <br />Owner/Operator-Telephone: <br />2 <br />Program Element: • b 3 2 <br />Program Record:2 �--� <br />Inspection Type: <br />s No <br />SB180 Posted Q_!!-S) <br />Permit Posted Yes No <br />Re -Inspection on or After: <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />J <br />A e <br />y —T <br />1-4 \_4 MCI <br />i <br />b <br />C <br />P s' <br />Item/Location <br />Temperature <br />Item / Location <br />1 Temperature <br />y� c= <br />- <br />Food Safety Certification <br />Facility Hot Water Temperature <br />Warewashing <br />Name: <br />Hand Sink: SOS <br />of <br />Chlorine: Ppm <br />Heat: of <br />Exp. Date: <br />Warewashing Sink: <br />of <br />Ouat. Amm.: PPM <br />Other: of <br />Received By / Title: <br />EH Specialiste <br />Phone: `,�1_ sc) <br />TimeOD <br />in: y 2 <br />Time Out: l ®t Pagel f 2 <br />EHD 16-24 (2n1 pg) 4/3/13 FOOD PROGRAM OR CONTINUATION <br />