Laserfiche WebLink
0' °"!"�C <br /> SAN JOAQUIN COUP' <br /> � � <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> -_ 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax:(209)464-0138 Web:www.sigov.org/ehd <br /> ��FORN <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: / Date: <br /> Address: / dr // City: Zip Code: D <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 /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> Item/Location ? Temperature Item/Location Temperature <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: 'F Chlorine: _ppm Heat: of <br /> Exp.Date: Warewashing Sink: °F Quat.Amm.: ppm Other: of <br /> Received By/Tit[ e <br /> EH Specialis Phone: <br /> Time in: 9 �-s Time Out: / l Page ,of <br /> EHD 16-24 (2nd pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />