Laserfiche WebLink
SAN JOAQUIN COUS <br /> •.OG <br /> .z� ENVIRONMENTAL HEALTH DEPARTMENT <br /> _ = 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax: (209) 464-0138 Web:www.si4ov.orq/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: fff,evl�cclucx 140 <br /> I0 Date: I U14/16- <br /> ddress: �'005 Y'4 <br /> Y'4 flI *ane City: 1-� Zip Code: <br /> Owner/Operator: -AI e_ tom, �r' r r 7 1 Telephone: <br /> Program Element: 6� Program Record: V/�G) •s,0 i- Inspection Type: �1 <br /> SB180 Posted Yes ❑ Rermit Posted Yes ❑1 v Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> U CICU '(Ce nfjO un Le - <br /> So1 i cmgt4ed 0f �i <br /> rrn <br /> Item/Location Temperature �� Item 1 Location Temperature <br /> ....____.._......... <br /> i <br /> �+ F —__re mg <br /> Name: Hand S <br /> Food Safe CertificationSink: <br /> Facility o Not Water Temperature Chlorine: Warwa.shlHeat. of <br /> PPM <br /> Exp.Date: Warewashing Sink: of Quat. Amm.: <br /> it ppm 'Other: of <br /> Received By/Title: <br /> EH Specialist: Phone: <br /> Time in: (,{ 14 <br /> � Time Out:/t1`'1 Page of <br /> EHD 16-24 (211pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />