Laserfiche WebLink
SAN JOAQUIN COUN' <br /> a` X ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • ... = ;p• Telephone: (209) 468-3420 Fax:(209) 464-0138 Web:www.s'gov.org/ehd <br /> 4L/FpRN <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: �, �- �� f2 Date: Z L <br /> City: ` Zip Code: <br /> Address: - <br /> Owner/Operator: ✓ Telephone: <br /> Program Element: /,q Program Record: S _3-7G- t/ Inspection Type: <br /> SB180 Posted _ Yes l No Permit Posted Yes No Re-Inspection on or After: <br /> WW MEMIN <br /> L <br /> �- U1 - 0 <br /> ;Y-M4- w kls fW 4En- lf -V- lav — D <br /> r 3 IF <br /> — <br /> j 11 LC V <br /> 1l �✓ <br /> SOu✓ CI' AVN R C� Grqdp <br /> Pblflm I iyfk(� <br /> - <br /> C.N.-I? <br /> {vvt M fit I C <br /> b7ifil/ o - <br /> 1'wmw n Jiv — 3 <br /> Ml <br /> s rV1 <br /> a ri 7 d a/ <br /> Name: Hand Sink: of Chlorine: ppm Heat: of <br /> Exp.Date: Warewashing Sink: of Quat.Amm.: ppm Other: of <br /> Received By/Title: <br /> EH Specialist: ». Phone: <br /> Time in: Time Out: IX, -27 J Page of <br /> EHD 16-24 (2n°pg) 4/3/13 1 FOOD PROGRAM OIR CONTINUATION <br />