Laserfiche WebLink
SAN JOAQUIN COUP <br /> a` ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • �4.,, •.a�P• Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.sugov.org/ehd <br /> L(FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: f-i 'O Date: 3() 4 <br /> Address: t2w ad o C-+- City: CVDC*ft P Zip Code: "Iq;z-0(0 <br /> Owner/Operator: i1 CkS Telephone: <br /> Program Element: r\(D Z3j Program Record: PR G)i L-)I I Inspection Type: 115 V�'l <br /> S131 80 Posted Yes ❑ No Permit Posted ❑Yes [] No Re-Inspection on or After: -� <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> �►t� v kkku iMS. ha\/e <br /> n lam aril S can s 4e __ <br /> Item/Location Temperature Item/Location Temperature <br /> Food Safety Certification Facility Hot Water Temperature Warewashing' <br /> Name: Hand Sink: of Chlorine: tob ppm Heat: of <br /> Exp.Date: Warewashing Sink: of Ouat.Amm.: ppm Other: of <br /> Received By/Title: <br /> EH Specialist: Phone: 0a <br /> Time in: I U , U(J Time Out: t 1 V Page'l of <br /> EHD 16.24 (2nd pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />