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asAulN• SAN JOAQUIN COUNTY <br /> ? 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.sigov.org/ehd <br /> t�Foa`' <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility:— oti�R Date: <br /> Address: City: Zip Code: <br /> Owner/Operator: Telephone: <br /> Program Element: Z bq Program Record: ' Z Inspection Type: <br /> 6180 Posted 0 Yes ❑ permit Posted Yes ❑1 Re-Inspection on or After: <br /> to Q� C •r'35 <br /> V „-c Oio l <br /> A-\ <br /> C <br /> S P \ ' o; <br /> q C S; <br /> M <br /> 5 0 ' <br /> 5th_,tea .F <br /> ame: and Sink: .F hlorine: PPM r <br /> eat: .F <br /> xp.Date: arewashing Sink: 'F r <br /> uat.Amm.: ppm ther: .F <br /> eceived By I Title: _ <br /> �Ae <br /> EH Specialist: - Phone: � _033C> <br /> ime in: t 5 Time Out: Page of <br /> EHD 16-24(2n0 pg) 4013 FOOD PROGRAM OIR CONTINUATION <br />