Laserfiche WebLink
SAN JOAQUIN COL Y <br /> y� ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • c4.• _ ��P. Telephone:(209) 468-3420 Fax: (209)464-0138 Web:www.sigov.org/ehd <br /> <<FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: <br /> Address: City: Zip Code: <br /> Owner/Operator: Telephone: <br /> Program Element: Program Record: Inspection Type: <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> . . <br /> s. <br /> ;. <br /> .� Q rig OS <br /> a+- �rA rU WG41 s �i(M i6 <br /> OCT-r <br /> V ftT Cm 641C WA- 611ti is q"l G n2 . <br /> U <br /> 16LP arru� <br /> umCtO vn c(jVeA W (avP2.10j' _ 0- Asn=+ S Q <br /> �3wwz itn ` C <br /> Item/Location j Temperature ttcafion Temperatur <br /> I <br /> -a <br /> Food Safety Certificated Facility tiot 1fllater Temperatwashing s=: <br /> Name: iHand Sink: of Chlorine: ppm IHeat: of <br /> Exp.Date: �aarewashing Sink: of Ouat.Amm.: ppm Other. of <br /> Received By/Title I J P_ <br /> EH Specialist: Phone: � J! - <br /> Time in: Time Out: Page�f <br /> EHD 16-24 (2n°pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />