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Time In: 137 prn <br /> Time Out: 2:19 pm <br /> �.... .. P San Joaquin County <br /> .X Environmental Health Department <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • �•.• �P Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.sigov.org/ehd <br /> '9C%FORM <br /> Food Program Service Request Inspection Report <br /> Name of Facility: VILLAGE COFFEE SHOP, INC Date: 09/21/2016 <br /> Address: 416 W LODI AVE , LODI 95240 <br /> Requestor: STEVE WEIL&JULIANNA JETTE,VILLAGE COFFEE SHOP, INC Telephone: <br /> Program Element: 1602-FOOD CONSULTATION Request#: SR0075819 <br /> Inspection Type: 061 -CONSULTATION <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 /> OVERALL INSPECTION NOTES AND COMMENTS <br /> OBSERVATIONS <br /> Name on Food Safety Certificate: Julianna Jette Expiration Date:August 19,2019 <br /> Warewash Chlorine(Cl): ppm Heat: °F Water/Hot Water Ware Sink Temp: 120°F <br /> Quaternary Ammonia(QA): ppm Hand Sink Temp: 120°F <br /> FOOD ITEM--LOCATION--TEMP°F--COMMENTS <br /> 1 door under prep--41.00°F 2 door under prep--41.00°F <br /> Norris milk refrigerator--41.00°F hand sink--restroom--101.00°F <br /> pie display--41.00°F 3 comp--120.00°F <br /> NOTES <br /> All existing equipment. <br /> Same menu. <br /> PE 1624 <br /> Ok to issue permit once fee paid. <br /> Operator to return to 1868 E Hazelton and pay fee. <br /> Please backdate to August 22 <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 /> 4 <br /> Received by: Name and Title: Steven Weil, President <br /> EH Specialist: STEPHANIE RAMIREZ Phone: (209)468-9851 <br /> FA0001042 SR0075819 SC061 09/21/2016 <br /> EHD 16-23 Rev.06/30/15 Page 1 of 1 Food Program Service Request Inspection Report <br />