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`'.. ll � � �A�] I N Environmental Health Department <br /> `- Irl +lJ <br /> L.. v•:v COUNTY <br /> 7fa�p[r+85S growshere. Time In: 9.30 am <br /> Time Out: 10:25 am <br /> Food Program Official Inspection Report <br /> Name of Facility: LODI USD-ANSEL ADAMS ELEMENTARY Date: 04/22/2021 <br /> Address: 9275 GLACIER POINT DR, STOCKTON 95212 <br /> Owner/Operator: LODI UNIFIED SCHOOL DISTRICT Telephone: (209)331-7000 <br /> Program Element: 1632-EXEMPT FOOD <br /> Inspection Type: ROUTINE INSPECTION (Chargeable) <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: Leanna Nava Expiration Date:July 19,2023 <br /> Warewash Chlorine(Cl): ppm Heat: 160°F Water/Hot Water Ware Sink Temp: 120°F <br /> Quaternary Ammonia(QA): ppm Hand Sink Temp: 100°F <br /> FOOD ITEM--LOCATION--TEMP°F--COMMENTS <br /> Walk in cooler--41.00°F Hand washing sink--Restroom--100.00°F <br /> Beverage air milk cooler#2--Cafeteria--40.00°F Beverage air milk cooler#1 --Cafeteria--40.00°F <br /> 2 Dr Metro C200 hot hold--Kitchen--190.00°F <br /> NOTES <br /> Spring routine inspection. <br /> Sanitizer bucket: 200 PPM QUAT <br /> Facility is preparing hot and cold lunches for the students on side, Monday through Friday. Lunch occurs between 10:50am- <br /> 12:30pm. <br /> Facility orders their food items from SYSCO and the Lodi Unified School District warehouse. <br /> All food is prepared and warmed on site, during operational use. <br /> Not all food equipment is in use at this time. <br /> Observed no major violations at this time. <br /> Official inspection report emailed. <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: Leanna Nava, Kitchen manager <br /> EH Specialist: VICTOR ACEVEDO Phone: (209)616-3023 <br /> FA0015582 PR0523085 SC101 04/22/2021 <br /> EHD 16-23 Rev.09/16/2020 Page 1 of 1 Food Program OR <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjgov.org/EHD <br />