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SAN JOAQUIN COUNte <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.siooy.org/ehd <br /> �IFdM� <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: o n IN Date: _ 7 <br /> Address: 3 )-Go Jci Pn i City: Trcr t' Zip Code: 91 7 <br /> Owner/Operator: Telephone: F J <br /> Program Element: Program Record: Inspection Type: �, e <br /> B180 Posted 0 Yes ❑ No Permit Posted 0 Yes 0 No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> Temperature l ' ltemlLocation Temperature Item Location perature <br /> - - � � <br /> Name: r,. I f/ + and Sink: �Gv 'F hlorine: ppm Heat: 16 C 'F <br /> Exp. Date: , l ) arewashing Sink: / -F Lat.Amm.: 2�o ppm Other: -F <br /> Received By/Title: <br /> EH Specialist: Wte� ne: <br /> Time in: Time Out: Page of <br /> EHD 1624 (2n0 pg) 1112M FOOD PROGRAM OR CONTINUATION <br />