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Environmental Health Department <br />Time In: <br />12:30 pm <br />10:35 am <br />Time Out: <br />Program Element: 1619 - RETAIL MKT >1000 SQ FT (=/>2 DEPTS) <br />Telephone: (425) 313-8100 Owner/Operator: COSTCO WHOLESALE CORPORATION <br />Inspection Type: ROUTINE INSPECTION - Operating Permit <br />Address: 2680 REYNOLDS RANCH PKWY, LODI 95240 <br />Date: 04/21/2021Name of Facility: COSTCO WHOLESALE #1091 <br />Food Program Official Inspection Report <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 /> #35 Equipment/Utensils Approved and in Good Repair <br />OBSERVATIONS: The handle for the lid on the smoothie mix machine is broken. Provid a new lid by 1 week. <br />CALCODE DESCRIPTION: All utensils and equipment shall be fully operative and in good repair. (114175). All utensils and equipment <br />shall be approved, installed properly, and meet applicable standards. (114130, 114130.1, 114130.2, 114130.3, 114130.4, 114130.5, <br />114132, 114133, 114137, 114139, 114153, 114155, 114163, 114165, 114167, 114169, 114172, 114177, 114180, 114182) <br />Chlorine (Cl): <br />Name on Food Safety Certificate:Expiration Date: <br />ppmQuaternary Ammonia (QA): <br />Heat:ppm º FWarewash Water/Hot Water Ware Sink Temp:º F <br />Hand Sink Temp:º F <br />OBSERVATIONS <br /> 300 <br /> 120 <br /> 100 <br />Timothy Stone March 23, 2026 <br />OVERALL INSPECTION NOTES AND COMMENTS <br />dairy walk in -- 40.00º F ice cream mix -- food court -- 37.00º F <br />walk in -- food court -- 36.00º F ground beef display -- 38.00º F <br />3 door prep -- pizza prep -- 37.00º F walk in -- bakery -- 38.00º F <br />walk in -- store -- 37.00º F chicken case -- 39.00º F <br />cheese -- 40.00º F 2 door prep -- smoothie prep -- 39.00º F <br />smoothie mix -- food court -- 41.00º F walk in -- meat department -- 30.00º F <br />fish display -- 38.00º F carbon dioxide -- 1 large and 1 small -- 550.00º F <br />walk in -- bakery -- 38.00º F carne asada display -- 40.00º F <br />FOOD ITEM -- LOCATION -- TEMP º F -- COMMENTS <br />NOTES <br />sanitizer buckets throughout store - 300 ppm quat <br />no signature due due covid 19 <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:Phone: <br />, <br />NICHOLAS WIESEMAN <br />Page 1 of 1EHD 16-23 Rev. 06/30/15 Food Program OIR <br />FA0020431 PR0536360 SC001 04/21/2021 <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjcehd.com