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SAN JOAQUIN COUP' <br /> 4' �a ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.sigov.org/ehd <br /> �fFOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: TT-CM(A-) 06A r-1 elt Date: 2�SJ S <br /> Address: <br /> 16 , City: SA-0uL�M-p Zip Code: G <br /> Owner/Operator: Al -i L \S1 ��Q n� 1 Telephone: A CA(6-Z <br /> Program Eleme �j ttb 1 Program Re ord• �0( (D 1 OIG Inspection Type: <br /> SB180 Posted Yes No Vv Permit Posted es No I Re-Inspection on or After: <br /> . . QBSEF#1ir-ANMI <br /> __-___-..._.._._..___ -___..._...._ <br /> ...... .............. _ _ - <br /> z is 1y-i R C O v S do <br /> 0 hti a •-T w sodo o S - an texiq <br /> 1 cn w P - <br /> v ic�u S or <br /> ►x+11 wu\ ul= <br /> WCA 1, i n <br /> _ fry i#�f� R V raturej MM <br /> sFiing` `-� <br /> _ <br /> s: <br /> Name: Hand Sink: <br /> o o 'FChlorine: lky i ppm Heat: 'F <br /> Exp.Date: Warewashing Sink 'F Quat.Amm.: ppm Other: 'F <br /> -i- _ <br /> Received By/Title: <br /> EH Specialist: Phone: <br /> Time in: _ Time Out: i ¢� PageZof]` <br /> EHD 16-24 (2^'pg) 4/3/13 1 FOOD PROGRAM OIR CONTINUATION <br />