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SA NUJ OAHU I N Environmental Health Department <br /> L■ COUNT Y-- <br /> c/ p, Greorne5S grows hey,. Time In:�50pm <br /> Time Out: 1:50 om <br /> Food Program Official Inspection Report <br /> Name of Facility: LODI USD-ANSEL ADAMS ELEMENTARY Date: 09/27/2018 <br /> Address: 9275 GLACIER POINT DR, STOCKTON 95212 <br /> Owner/Operator: LODI UNIFIED SCHOOL DISTRICT Telephone: (209)331-7179 <br /> Program Element: 1632-EXEMPT FOOD <br /> Inspection Type: ROUTINE INSPECTION -Operating Permit <br /> VIOLATIONS AND CORRECTIVE ACTIONS <br /> Items listed on this report as violations do not meet the requirements set forth in the California Health and Safety Code commencing with section 7; <br /> 113700.All violations must be corrected within specified timeframe. Violations that are classified as"MAJOR"pose an immediate threat to public health <br /> and have the potential to cause foodborne illness.All major violations must be corrected immediately.Non-compliance may warrant immediate closure of <br /> the food facility. <br /> #41 Plumbing Maintained;Approved Back Flow Device <br /> OBSERVATIONS:Hand sink by the washing area is slowly draining. Repair in 1 week. <br /> CALCODE DESCRIPTION:The potable water supply shall be protected with a backflow or back siphonage protection device,as required <br /> by applicable plumbing codes. (114192)All plumbing and plumbing fixtures shall be installed in compliance with local plumbing <br /> ordinances, shall be maintained so as to prevent any contamination,and shall be kept clean,fully operative,and in good repair. Any hose <br /> used for conveying potable water shall be of approved materials,labeled,properly stored,and used for no other purpose. (114171, <br /> 114189.1, 114190, 114193, 114193.1, 114199, 114201, 114269) <br /> OVERALL INSPECTION NOTES AND COMMENTS <br /> OBSERVATIONS <br /> Name on Food Safety Certificate: Mary Patterson Expiration Date:June 02,2020 <br /> Warewash Chlorine(Cl): ppm Heat: 160°F Water/Hot Water Ware Sink Temp: 124°F <br /> Quaternary Ammonia(QA): 300 ppm Hand Sink Temp: 108°F <br /> FOOD ITEM--LOCATION--TEMP°F--COMMENTS <br /> Metro C 200 warmer--Kitchen--141.00°F Prep sink--135.00°F <br /> Hand sink--Employee rest room--110.00°F Metro C 200 warmer--Dining--150.00°F <br /> Bev Air cooler milk--Right/dining--39.00°F 2 D Cres Cor warmer--Dining--140.00°F <br /> Bev Air cooler milk--Left/dining--45.00°F Walk in cooler--41.00°F <br /> NOTES <br /> Sanitizer bucket is set up with QUAT 300 ppm. <br /> Time log for salad bar is maintained. <br /> No major violations were observed. <br /> OIR emailed to coliver@lodiusd.net; mpatterson@lodiusd.net <br /> FA0015582 PR0523085 SCO01 09/27/2018 <br /> EHD 16-23 Rev.06/30/15 Page 1 of 2 Food Program OR <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br />