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SAN JOAQUIN COUNTY <br /> r` ry ENVIRONMENTAL HEALTH DEPARTMENT <br /> N a <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> r.., .P Telephone: (209) 468-3420 Fax: (209)464-0138 Web:www.sigov.org/ehd <br /> 9CikSaN� <br /> .FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: ✓ Date: S/ 114alul <br /> Address: City: Zip Code: <br /> Owner/Operator: t-Arn 14 d Telephone: S-L-3 <br /> Program Element: Pkp rogram Record: Inspection Type: <br /> SB180 Posted 0 Yes 0 No Permit Posted []Yes 0 No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> (i LZ. 9 l 0 �114e-.A� Z <br /> IlkL fL/-t <br /> ItemlLocation prTemperature ' - dtem.l Location Temperature Item/-Location Temperature <br /> 'Food Safety Certification _ _ Facility Hot Water Temperature W_arewashin19 <br /> Name: Hand Sink: eF Chlorine_ ppm Heat: of <br /> Exp.Date: - arewashing Sink: of Quat.Amm.: ppm Other: of <br /> Received By I Title: 67 91 �. 4lic'N q <br /> EH Specialist: J� Pha e: qla <br /> Time in: fl v Time Out: ' 3 3 Page/of <br /> EHD 16-24(2n° ) 11/2109 FOOD PROGRAM OF CONTINUATION <br />