Laserfiche WebLink
oQ"'" c <br />SAN JOAQUIN COUN . r' <br />Q` ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: vuww.sjyov.org/ehd <br />��FOR <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT, <br />Name of Facility: <br />Date: /� 0 <br />Address: � City: <br />Zip Code; <br />Owner/Operator: �S <br />J <br />q elephone: <br />Program Element: Program Record: � -' <br />16 <br />Insp tion Type: <br />3W <br />SB180 Posted D Yes F1 No Permit Posted D Yes D No <br />Re -Inspection on or After: <br />EHD 16-24 (2nd pg) 4/9/12 FOOD PROGRAM OR CONTINUATION <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />IL <br />CSU 1� U4 <br />ce �-C� <br />o <br />Item/Location <br />Temperature <br />Item / Location <br />Temperature <br />Item / Location <br />Temperature <br />Food Safety Certification <br />Facility Hot Water Temperature <br />Warewashing <br />Name: <br />Hand Sink: <br />of <br />Chlorine: <br />ppm <br />Heat: of <br />Exp. Date: <br />Warewashing Sink: <br />of <br />Quat. Amm.: <br />ppm <br />Other: of <br />Received By / Title: <br />EH Specialist: <br />Phone: <br />Time in:"1141rl <br />' o 6T <br />Time Out: <br />Pag of <br />EHD 16-24 (2nd pg) 4/9/12 FOOD PROGRAM OR CONTINUATION <br />