Laserfiche WebLink
�a�1N SAN JOAQUIN COUP <br /> 2. Z ENVIRONMENTAL HEALTH DEPARTMENT <br /> - _ 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> cq'•.,,-`,,.NSP Telephone:(209)468-3420 Fax:(209) 464-0138 Web:www.sigov.org/ehd <br /> L�FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: G Date: 1/(0 <br /> zi <br /> c <br /> Address: I � e cm n City: s 1 U tYl Zip Code: <br /> Owner/Operator: .Telephone: f �—V <br /> 11)�'N Ca nC� 'h P _'�v 4 <br /> Program Element: Program Recor Inspection Type: <br /> SB180 Posted Yes No Permit Posted Yes No Re-inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS_ <br /> _............._._....—......-. <br /> r _ _- s o\ c <br /> G fit tlr cc*k e e_ f nGtC� 1112 5 .. <br /> caf-t-� <br /> Item/Location i.Temperature I� Item I Location Temperature <br /> - <br /> \N Ui\k n (duo � . — ---- — <br /> I <br /> __.. <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: U °F Chlorine: PPM Heat: `F <br /> Exp.Date: arewashing Sink: U of lQuat.Amm.: PPM Other: of <br /> Received By/Title: T� <br /> EH Specialist: Phone: 4 <br /> Time in: g" Time Out: ' Page of <br /> EHD 16.24 (2nd pg) 4/3/13 FOOD PROGRAM OR CONTINUATION <br />