Laserfiche WebLink
SAN JOAQUIN COUP <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> X <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • •. :P• Telephone:(209)468-3420 Fax: (209) 464-0138 Web:www.sigov.org/ehd <br /> 4��FORa <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: r� Date: I02F 27 <br /> Address: T. City: Zip Code: <br /> r <br /> Owner/Operator: + 3 Telephone:(��� <br /> Program Element: Program Record: Inspection Typ dw ' <br /> 6180 Posted Yes No Permit Posted Yes o Re-Inspection on or After: <br /> y <br /> OBSERVATIONS AND CORRECTIVE ACTIONS ; <br /> JS i "_, <br /> s <br /> Ace 'e <br /> Item/Location Temperature Item/Location Temperature <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: of Chlorine: ppm Heat: 'F <br /> Exp.Date: arewashing Sink: of Ouat.Amm.: ppm Other: of <br /> Received By/Title: ,� —a.. ( h <br /> EH Specialist: V Phone: <br /> Time in: I/ n Time Out: 1 — Page of <br /> EHD 16-24(2^d pg) 4/3/13 r/ FOOD PROGRAM OIR CONTINUATION <br />