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SAN JOAQUIN COUNT <br /> ).•' 'COG <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> _ 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • c... _. iP• Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.sigov.org/ehd <br /> '9C%FO'Ria <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: e 1 ✓ F.flGU I Date: � I <br /> Address: ZCity: Zip Code: <br /> Owner/Operator: rcI-ACA 1` M cfeq 0 Telephone: ?)42 <br /> Program Element: ('0CL U Program Record: �,�,0 J Inspection Type:✓(Cm laff'I-I+ <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> v eft-a C TP uc_ . -rhe u[/l & (-e, 974-- -Tbe_ <br /> w�� - , <br /> V c,1 + .P GIn CJM Corel e rn c i1�� <br /> iz 1 vco-e �,cmQ, <br /> Item/Location Temperature Item/Location Temperature <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: of Chlorine: LL Heat: 'F <br /> Exp.Date: arewashing Sink: of Ouat.Amm.: ther: of <br /> Received By/Title: Y , <br /> EH Specialist: I Phone: n .- <br /> Pa <br /> ime in: . Time Out: C ge of <br /> EHD 16-24 (2nd pg) 4/3113 FOOD PROGRAM OIR CONTINUATION <br />