Laserfiche WebLink
*j 0*PSAN JOAQUIN COUP <br /> �.COG <br /> 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.sl4ov.orq/ehd <br /> 4��FORN <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: 0 c q ' ui r c Date: _ ) _ <br /> Address: t, }r City: r�# Zip Code: C/S- 7 <br /> Owner/Operator: L�� V I d Telephone: / <br /> Program Element: i Program Record: S C (, yk Inspection Type: <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> U oif <br /> ff <br /> r c+. n i n <br /> fel v,' o0 07Gnc; CO <-e 0 �c <br /> �r ✓yVM © I"Pr uC� �� f � ��o► �n � Pr J G .� � frPc <br /> G <br /> a 6 r, v <br /> on Temperature Item 1 Location Temperature Item/Location T Temperature <br /> �aaaafety Ger#ification ., Facility Hot Water Temperature Warewashing <br /> - -- _ Cru -- -- - -- - - <br /> Name: Hand Sink: of Chlorine: ppm Heat: of <br /> Exp.Date: Warewashing Sink: of ruat.Amm.: ppm Other: of <br /> Received By/Title: '' ! <br /> r) haji <br /> EH Specialist: - l - Phone: J� dl- <br /> Time in: R e S')_ <br /> ') Time Out: Page of <br /> E,dD 16-24 (2nd pg) 4/9/12 1 FOOD PROGRAM OIR CONTINUATION <br />