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S A I D J O M Q V I N Environmental Health Department <br /> COU N7Y <br /> Food Program Official Inspection Report <br /> Facility Name and Address: COUNTRYSIDE LIQUORS&GAS, 14971 N HWY 88 , LODI 95240 <br /> OVERALL INSPECTION NOTES AND COMMENTS <br /> OBSERVATIONS <br /> Name on Food Safety Certificate: Expiration Date: <br /> Warewash Chlorine(Cl): ppm Heat: °F Water/Hot Water Ware Sink Temp: 120°F <br /> Quaternary Ammonia(QA): ppm Hand Sink Temp: 100°F <br /> FOOD ITEM--LOCATION--TEMP°F--COMMENTS <br /> 3-Door Reach In--Market--41.00°F Walk-In--Market--41.00°F <br /> NOTES <br /> Routine inspection conducted this date,the followings were noted: <br /> Prepackaged food, Soda, Cofee and Donut. <br /> Inspection report was discussed with Israr Ahmad, Manager. <br /> Maintain a copy of this inspection report on site. Inspection report will be e-mailed and texted to facility. <br /> The person in charge is responsible for ensuring that the above mentioned facility is in compliance with all applicable sections of the California Health and <br /> Safety Code.If a reinspection is required,fees will be assessed at the current hourly rate. <br /> A"\_� <br /> Received by: Name and Title: Israr Ahmad, Manager <br /> EH Specialist: STEVEN SHIH Phone: (209)616-3152 <br /> FA0000540 PRO161897 SCO01 07/22/2020 <br /> EHD 16-23 Rev.06/30/15 Page 2 of 2 Food Program OIR <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br />