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i �� I I I AI Environmental Health Department <br /> YSA N U N <br /> r�■z�w� COUNTY <br /> Greorness grows here. <br /> Food Program Service Request Inspection Report <br /> Facility Name and Address: SOUL NUTRITION, 263 E LOUISE AVE , LATHROP 95330 <br /> OK to permit as a 1623 once the annual permit fee is paid. <br /> Pay the annual permit fee prior to operation: inspector will e-mail the online payment link <br /> 5021 filled out/photo of ID taken <br /> No signature obtained/COVID-19 <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 /> Received by: Name and Title: Discussed w/Rosa Johnson, owner <br /> EH Specialist: KADEANNE LINHARES Phone: (209)468-0330 <br /> FA0025309 SR0082398 SC061 08/05/2020 <br /> EHD 16-23 Rev.06/30/15 Page 2 of 2 Food Program Service Request Inspection Report <br />