Laserfiche WebLink
oP41'" SAN JOAQUIN COON# <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 0: 1 X <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> �q.. •..•gip Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.sigov.org/ehd <br /> �IFORa <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: a1,CA n n( Date: <br /> roQ d_5S 2q-12 <br /> Address: a G U 1- I U City: U Zip Code: C1 S✓2 7- <br /> Owner/Operator: r Telephone: 3 <br /> Program Element: Program Record: Inspection Type: <br /> SB180 Posted ❑Yes _ No Permit Posted L Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> rdV,% Q r r 1 , <br /> AP 0 kJ L/ <br /> U 6AL) fro I rte; 1 C i n <br /> I-tem/LocatIon m ature Item/Location Temperature Item/Location Temperature <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: of Chlorine: ppm Heat: of <br /> Exp.Date: Warewashing Sink: of Quat.Amm.: ppm Other: of <br /> Received By/Title: <br /> EH Specialist: i, Phone: " <br /> j(, k <br /> .0 b 0 • 3 <br /> ime in: Time Out: 7 Page of <br /> EHD 16.24 (2nd pg) 1/18/12 FOOD PROGRAM OIR CONTINUATION <br />