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SAN =J OAQ U I N Environmental Health Department <br /> COUNTY- <br /> �c,F❑�t' Greotness grows hers. <br /> Mobile Food Facility Service Request Inspection Report <br /> Facility Name and Address: FLAVOR FUSION#4RW1282, 620 S SACRAMENTO ST , LODI 95240 <br /> OBSERVATIONS <br /> Name on Food Safety Certificate: Phero Nguyen Expiration Date: December 10,2026 <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 /> 1 D Atosa--40.00°F <br /> NOTES <br /> Consultation inspection. <br /> LIC#4RW1282 <br /> VIN...L1065209 <br /> Chlorine test strips available. <br /> Provided SB180. <br /> Discussed report with operator. <br /> No signature captured. <br /> New completed commissary form or verification from Stanislaus county REHS is required before permit can be issued. <br /> PE 1635,fee$237 <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: <br /> EH Specialist: DARIA AFONSKAIA Phone: (209)616-3035 <br /> FA0026137 SR0086209 SC061 12/30/2022 <br /> EHD 16-23 Rev.09/16/2020 Page 2 of 2 Mobile Food Facility Service Request Inspection Report <br />