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SAN JOAQUIN COUN, <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax: (209) 464-0138 Web:www.sqgov.org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: "i ICA I 01-C V CA Date: <br /> Address: City: Zip Code: <br /> Owner/Operator: alpwTelephone: 00- <br /> Program Element: 4b 4 Program Record: 17) -1)Ll Inspection Type: <br /> SB180 Posted F-Yes I Rermit Posted El Yes 0 1 Re-inspection on or After: <br /> WoCK4ed i ME* I-CAWNS <br /> �N' I I h 11-X1 UIPMOP nalre--, Qbj \1Y C'iA� <br /> q I I-tui <br /> V-`nt A A'\ <br /> Name, and Sink: *F h1lorine: pp. sat: 'F <br /> Exp.Date: P arewashing Sink: of uat.Amm.: PPM E r: F <br /> Received By I Title: <br /> H Specialist: Phone: <br /> ime in: Time Out: <br /> 100A Page of <br /> FHD16-24 (2�pg) 413113 FOOD PROGRAM OIR CONTINUATION <br />