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SAN =J OAQ U I N Environmental Health Department <br /> COUNTY- <br /> �c,F❑�t' Greotness grows hers. <br /> Food Program Service Request Inspection Report <br /> Facility Name and Address: MIMOSAS GOURMET, 117W ELM ST, LODI 95240 <br /> Signature was not captured. <br /> Owner/operator must obtain a food safety certificate within 60 days from the date the permit is issued and provide a copy of <br /> the certificate to this office.All other employees must obtain food handler cards within 30 day of the employment and maintain <br /> records at the facility. <br /> Okay to issue permit for program element 1624; ownership remains the same. Change the business name only <br /> Prior to operating this business, owner should return to this office, 1868 E. Hazelton Ave, Stockton,to complete the facility <br /> information. The facility information form is provided on site. <br /> NOTICE: Currently entering the EHD building is by APPOINTMENT ONLY. Please call (209)468-3420 to be directed to the <br /> appropriate person to make the appointment. <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: Yusay Ibarra, Owner <br /> EH Specialist: STEVEN SHIH Phone: (209)468-9850 <br /> FA0013898 SR0081927 SC061 03/25/2020 <br /> EHD 16-23 Rev.06/30/15 Page 2 of 2 Food Program Service Request Inspection Report <br />