Laserfiche WebLink
SAN JOAQUIN COU f <br /> y-� ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • c... ;P• Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.s*gov.org/ehd <br /> 4C/FO'ftia <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility:e C Date: 113 <br /> Address: City: Zip Code: <br /> Owner/Operator: Telephone: <br /> Program Element: r Program Record: Insp $r Typq: <br /> B180 Posted Yes Nol Permit Posted Yes No Re-Inspection on or After: l <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> J 1 l�Irtu IjL <br /> l h Ce <br /> kl <br /> ie7 , <br /> U t V'� <br /> V G <br /> ( t. <br /> Item/Loca o�t n Temperature Item/Location Temperature <br /> ----- ---— T --- - --....__ .... - <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> -------- ... ._---_.._..- -- ---------- <br /> Name: Hand Sink: of Chlorine: ppm Heat: of <br /> Exp.Date: Warewashing Sink: of Ouat.Amm.: ppm Other: of <br /> Received By/Title:�r� ^' f�V ' <br /> EH Specialist n /\ y_ Phone: <br /> Time in: d � V Time Out: 1' J / Page of <br /> EHD 16-24 (2n°pg) 4/3/13 / FOOD PROGRAM OR CONTINUATION <br />