Laserfiche WebLink
a <br /> 4"'" 0 SAN JOAQUIN COW <br /> Q` a ENVIRONMENTAL HEALTH DEPARTMENT <br /> _ 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • c4�%FOR`'�P• Telephone:(209) 468-3420 Fax:(209)464-0138 Web:www.slQov.org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: ; OS <br /> Address: •� City: Zip Code: O <br /> Owner/Operator: �' elephone: a <br /> Program Element: V Program Rec d: Insp ction Type: <br /> v' <br /> SB180 Posted Yes No Permit Posted -Yes N6 Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS "- <br /> r. � J <br /> }. . L.:A ,�i.i�., �l 7Li. <br /> 1r <br /> Item/Location Temperature Item/Location Temperature Item/Location Temperature <br /> Food Safety Certification Facility Hot Water Temperature Warewashing, <br /> Name: Hand Sink: of Chlorine: ppm Heat: of <br /> 6&0 4 P,pka k�Exp.Date: '?, Warewashing Sink: of Quat.Amm.: ppm they: 'F <br /> Received By/Title: <br /> EH Specialist: Phone <br /> ime in: Time Duf- i�, Page of <br /> EHD 16-24 (2^d pg) 4/9/12 FOOD PROGRAM OIR CONTINUATION <br />