Laserfiche WebLink
SAN JOAOUIN COUP <br /> 4 X ENVIRONMENTAL HEALTH DEPARTMENT <br /> - -- 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax:(209)464-0138 Web:www.sigov.or /q ehd <br /> LrFOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: �.� \je Date: <br /> Address: c v City: Sh�,r v'. Zip Code: <br /> Owner/Operator: / ,.,- 1jo, , n.►. ��n 1 Telephone: <br /> Program Element: lr `�Pr�ogram Record: �� U y �(� �-�� inspection Type: b�, , <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: ��(J� <br /> UBSERV,4TIflNS'AN©CflRRECTtVE As <br /> ------------—-- — <br /> \( �'1 Cln 5 <br /> OAF-- 'Vb <br /> rpiv CJU-S `�" <br /> iten�ILocation Temperature � Item I Location Ternperafure <br /> s. <br /> Food Safety Ce tification Facility Hot water Temperature Warewashing <br /> Name: Hand Sink: °F Chlorine. Ppm Heat: of <br /> Exp.Date: arewashing Sink: 'F Quat.Amm.: ppm Other: 'F <br /> Received By/Title: <br /> EH Specialist: Phone: <br /> Time in: ��.. Time Out: ;�� Page of <br /> EHD 1624 (20°pg)413113 FOOD PROGRAM OR CONTINUATION <br />