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oPR41N• SAN JOAQUIN COUA <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> c4.iFoa�,P Telephone;(209)468-3420 Fax:(209)464-0138 Web:www.sigov.org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: ref 'ra! i C- I (A J'r 4 & Date: /0,Jr13 <br /> - <br /> Address: )92 G city` 7_tg�Cj, zip code: ?5.?74 <br /> Owner/Operator: Telephone: <br /> Program Element: Program Record: Inspection Type: <br /> B180 Posted ❑Yes ❑ No Permit Posted ❑Yes ❑No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> � 0 4r i j - n <br /> 4 iS � u ; 1 I- C / <br /> i f cKrd RO/Mcvt inWIrems- <br /> ZM Icy ; n w a f Soppy <br /> a ter . CA la;n We, ler cls Or C, b 0,vc /001, <br /> rrrc 1oA <br /> S n. ; e . 0'o ce 1. <br /> Gid .2' Woo r � CAIC R <br /> 19 av, do It // rr ) UI �rur✓14rbie �p<G <br /> Gn �e II ,t!-dGGr� r I� hG1,()erS N� � <br /> --=�- -!: <br /> Facility Hot Water Temperature oF_ kChl.cri'�e'� <br /> wppma'Name: 1 Hand Sink: Heat r} = /I f `F <br /> Exp.Date: I / I, / arewashing Sink: i � t. Amm. T Ppm Other: of <br /> Received By/Title: �kyV G 1pt - <br /> EH Specialist: Phone: <br /> Time in: .Z Time Out: I • 1 f Page of <br /> EHD 16-24 (2b pg) 4013 J,J FOOD PROGRAM OIR GOWINUATION <br />