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SAN ) O A Q U I N Environmental Health Department <br /> Time In:-12:32-pm- <br /> Time <br /> _qnmTime Out: 1:00 pm <br /> Food Program Service Request Inspection Report <br /> Name of Facility: DELICIOUS BOARDS, LLC Date: 11/03/2022 <br /> Address: 1306 LAKEWOOD MALL , LODI 95242 <br /> Requestor: SAME Telephone: <br /> Program Element: 1601 -FOOD PLAN CHECK Request#: SR0085617 <br /> Inspection Type: 523- Plan Check/Report Review <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. Noncompliance may warrant immediate closure of <br /> the food facility. <br /> OVERALL INSPECTION NOTES AND COMMENTS <br /> OBSERVATIONS <br /> Name on Food Safety certificate: Carmen Gutierrez Expiration Date:June 13,2027 <br /> Warewash Chlorine(Cl): ppm Heat:_°F Water/Hot Water Ware sink Temp: °F <br /> Quaternary Ammonia(QA): ppm Hand Sink Temp: °F <br /> FOOD ITEM--LOCATION --TEMP°F--COMMENTS <br /> hand sink—shared restroom Women's-- 119.00°F 2 door upright Avantco--41.00°F <br /> hand sink-- 103.00°F 3 comp— 136.00°F <br /> hand sink—shared restroom Men's--121.00°F 3 door reach-in—under prep table—40.00°F <br /> mop sink-- 141.00°F <br /> NOTES <br /> PE 1613 <br /> Plan check final <br /> Ok to issue 2023 permit once fee is paid <br /> Observed discharge pipe that extends into the floor sink at 3 compartment sink. <br /> Provide a minimum of a 1" air gap between the top of the floor sink and the bottom of the discharge pipe. <br /> Corrected on site. <br /> Observed water heater simulateously wired together for a total of 8000 watts <br /> he 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 /> afety Code. If a reinspection is required,fees will be assessed at the current hourly rate. <br /> eceived by: Name and Title: Carmen Gutierrez, <br /> H Specialist: STEPHANIE RAMIREZ Phone: <br /> FA0022640 SR0085617 SG523 11/03/2022 <br /> D 16-23 Rev.06130115 Page 1 of 1 Food Program Service Request Inspection Report <br /> 53I1-k <br />