Laserfiche WebLink
SAN JOAQUIN COUNTY <br />a � •F9 <br />a ?� 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.siaov.ora/ehd <br />9CJkoR? <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />Name of Facility: AwS <br />XIGS <br />' <br />Date: <br />}J <br />Address: VI <br />` <br />City: <br />Zip Code: <br />Owner/Operator: <br />Telephone: <br />Program Element: U <br />V Pro§ram Record: t� r'J <br />Inspection Type: <br />SB180 Posted Yes o <br />Permit Posted es No <br />Re -Inspection on or After: <br />c> <br />OBSER <br />CORRECTIVE ACTIONS <br />l <br />C� <br />i <br />-- <br />Temperature <br />-' Item / Loeatf <br />" ° m - - lure <br />!IIIIIIIIIIIIIWfood Safety Certlhcation <br />Name:Hand <br />Sink: <br />"F hiorine: <br />ppm Heat: <br />'F <br />Exp. Date: <br />areweshing Sink: <br />'F uet. Amm.: <br />ppm Other: <br />of <br />. Received By/ Title: <br />�.N�Jy <br />1. <br />EH Specialist: wcw <br />Phone: <br />0(0 <br />1 <br />! <br />O <br />Time in: 20 <br />Time Out: W <br />1 CI <br />PagI 3 <br />EHD 16-24 (2o0 pg) 4013 FOOD PROGRAM OIR CONTINUATION <br />