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COMPLIANCE INFO_2011-2019
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1600 - Food Program
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PR0162835
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COMPLIANCE INFO_2011-2019
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Last modified
1/14/2021 3:56:37 PM
Creation date
1/15/2020 3:52:52 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
1600 - Food Program
File Section
COMPLIANCE INFO
FileName_PostFix
2011-2019
RECORD_ID
PR0162835
PE
1626
FACILITY_ID
FA0000990
FACILITY_NAME
Black Bear Diner
STREET_NUMBER
1703
Direction
E
STREET_NAME
YOSEMITE
STREET_TYPE
Ave
City
Manteca
Zip
95336
APN
20831011
CURRENT_STATUS
01
SITE_LOCATION
1703 E Yosemite Ave
P_LOCATION
04
P_DISTRICT
003
QC Status
Approved
Scanner
JCastaneda
Tags
EHD - Public
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East Bay Restaurant Supply Inc. -- --- -'-� <br /> 49-4th Street PACKING LIST <br /> EAst Oakland,CA 94607-4603 ----- - -- — _..� <br /> IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII VIII VIII VIIIIIII III <br /> Package No.: PKG0267219 <br /> CArlcns <br /> Document No.: SO730250 <br /> Document Date: 08/23/18 <br /> Page: 1 <br /> SOLD SHIP <br /> TO: BLACK BEAR DINER-MANTECA TO: BLACK BEAR DINER-MANTECA <br /> ATTN:BEN Ben <br /> en <br /> 1703 E. YOSEMITE AVENUE <br /> 1703 E.Yosemite Ave MANTECA,CA 95336 <br /> MANTECA, CA 95336 USA <br /> USA <br /> TEL: 209-239-6400 FAX: 209-239-6422 TEL: 209-239.6400 FAX: <br /> Customer No.: C038037 Shipping Agent: EBRS Ship Date: <br /> - 08/24/18 <br /> r Item No. - --- — --- <br /> Description <br /> _ Serial Na Qty.Packed _UoM <br /> CCKS61-MT Mega-Top Sandwich Prep US100318042700C40013 <br /> 1 EA <br /> EAst <br /> AY <br /> •RESTAUP�ANT SUPPLY INC- <br /> ; II <br /> .743.2526please take our survey at <br /> tr a chance to II <br /> Customer Signature: <br /> —____ Date: Driver Signature: S <br />
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