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S A I D J O M Q V I N Environmental Health Department <br /> COU N7Y <br /> Food Program Official Inspection Report <br /> Facility Name and Address: LA POBLANA, 600 S CENTRAL AVE, LODI 95240 <br /> #30 Food Storage/Display Properly Labeled <br /> OBSERVATIONS:An open bag of rice is being stored on the storage shelf. Empty the contents of ingredients into a clean, <br /> closed container. Use scoops with handles to scoop out the ingredients from the containers. <br /> CALCODE DESCRIPTION:Food shall be stored in approved containers and labeled as to contents. Food shall be stored at least 6" <br /> above the floor on approved shelving. (114047, 114049, 114051, 114053, 114055, 114067(h), 114069(b)) <br /> OVERALL INSPECTION NOTES AND COMMENTS <br /> OBSERVATIONS <br /> Name on Food Safety Certificate: Carlos Mejia Expiration Date:January 28,2021 <br /> Warewash Chlorine(Cl): 100 ppm Heat: °F Water/Hot Water Ware Sink Temp: 113°F <br /> Quaternary Ammonia(QA): ppm Hand Sink Temp: 100°F <br /> FOOD ITEM--LOCATION--TEMP°F--COMMENTS <br /> true 1 door display--behind front counter--34.00°F true 1 door prep--customer lobby--38.00°F <br /> walk in--40.00°F true 1 door display--kitchen--41.00°F <br /> NOTES <br /> sanitizer bucket- 100 ppm chlorine <br /> no signature due to 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: NICHOLAS WIESEMAN Phone: <br /> FA0014812 PR0521812 SCO01 05/19/2021 <br /> EHD 16-23 Rev.06/30/15 Page 2 of 2 Food Program OIR <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br />