Laserfiche WebLink
SAN JOAQUIN COUP <br /> y< ENVIRONMENTAL HEALTH DEPARTMENT <br /> = 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> �4 ;P Telephone: (209) 468-3420 Fax: (209)464-0138 Web:vvww.sigov.org/ehd <br /> �iFORa <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: a � �t ,J ; ` Date: <br /> Address: r� ,�i � 1� City: <br /> � � Zip Code: 17,E-Z�� <br /> Owner/Operator: CIU e 1 G1 G Telephone: q 15 --511,!5) <br /> Program Element: 3 Program ecordV1 U` I�L Inspection Type: (ut)w I(.fI l on <br /> SB180 Posted ❑Yes ❑ Permit Posted ❑Yes ❑1 Re-Inspection on or After: l <br /> OBSERVATIONS AND CORRECTIVE ACTIONS s <br /> (kn� v G,- 1 � ►� I <br /> v&hl ctc <br /> 1�o <br /> �-C)C-- -v i to i r <br /> r pr <br /> Name: i ,r'i 1 I �I CA Hand Sink: I G G of Chlorine: ppm Heat: of <br /> Exp.Date: 1"tlin/DL arewashing Sink: G(J of Quat.Amm.: ppm Other: of <br /> Received By/Title: 1 <br /> EH Specialist: Phone: o o , f_� `�� <br /> Time in: Time Out: o Pagel of <br /> EHD 16-24 (2'°pg) 41313 FOOD PROGRAM OR CONTINUATION <br />