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SAN ]OAQ U I N Environmental Health Department <br /> —CO U T Time In: 12-34 pm <br /> Time Out: 12:59 pm <br /> �c,F❑�t' Greotness grows hers. <br /> Food Program Service Request Inspection Report <br /> Name of Facility: CANTEEN @ COSTCO#1091 LODI BREAKROOM Date: 02/07/2020 <br /> Address: 2680 REYNOLDS RANCH PKWY, LODI 95240 <br /> Requestor: CANTEEN @ COSTCO#1091 LODI BREAKROOM, COMPASS GROUP US Telephone: (704)328-5184 <br /> Program Element: 1602-FOOD CONSULTATION Request#: SR0081434 <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: N/A Expiration Date: <br /> Warewash Chlorine(Cl): ppm Heat: °F Water/Hot Water Ware Sink Temp: °F <br /> Quaternary Ammonia(QA): ppm Hand Sink Temp: 100°F <br /> FOOD ITEM--LOCATION--TEMP°F--COMMENTS <br /> No Temperature Data Collected <br /> NOTES <br /> Consultation inspection. <br /> Micro market installed in the employee lounge. <br /> Consist of one cooler, one freezer and shelfing for prepackaged goods. <br /> Program element: 1615 <br /> Ok to issue permit once fees have been paid. <br /> Official inspection report emailed.1 Dr Imberu cooler-38F <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: Gabriel Godinez,Assistant GM <br /> EH Specialist: VICTOR ACEVEDO Phone: (209)468-0337 <br /> SR0081434 SC061 02/07/2020 <br /> EHD 16-23 Rev.06/30/15 Page 1 of 1 Food Program Service Request Inspection Report <br />