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COMPLIANCE INFO_2023
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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1600 - Food Program
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PR0523085
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COMPLIANCE INFO_2023
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Last modified
12/26/2023 8:45:35 AM
Creation date
4/18/2023 1:07:13 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
1600 - Food Program
File Section
COMPLIANCE INFO
FileName_PostFix
2023
RECORD_ID
PR0523085
PE
1632
FACILITY_ID
FA0015582
FACILITY_NAME
LODI USD-ANSEL ADAMS ELEMENTARY
STREET_NUMBER
9275
STREET_NAME
GLACIER POINT
STREET_TYPE
DR
City
STOCKTON
Zip
95212
APN
12430007
CURRENT_STATUS
01
SITE_LOCATION
9275 GLACIER POINT DR
P_LOCATION
01
P_DISTRICT
003
QC Status
Approved
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EHD - Public
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SAN <br /> J O a Q U I N Environmental Health Department <br /> C0U ;N i y <br /> Food Program Official Inspection Report <br /> Facility Name and Address: LODI USD-ANSEL ADAMS ELEMENTARY, 9275 GLACIER POINT DR, STOCKTON 95212 <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: 122°F <br /> Quaternary Ammonia(QA): ppm Hand Sink Temp: 100°F <br /> FOOD ITEM--LOCATION--TEMP°F--COMMENTS <br /> walk-in--39.00°F 1 D Crescor warmer--kitchen--165.00°F <br /> 2 D Crescor warmer--cafeteria--180.00°F Beverage Air milk cooler#1 --cafeteria--40.00°F <br /> hand sink--staff restroom--110.00°F prep sink--120.00°F <br /> Beverage Air milk cooler#2--cafeteria--40.00°F <br /> NOTES <br /> Routine inspection. <br /> Sanitizer bucket-200 ppm quat. <br /> Quat and thermolabel test strips available. <br /> Facility serves breakfast rom 7:45-8:15 AM and lunch from 10:25 AM- 12:10 PM. <br /> Facility receives food items from SYSCO and Lodi USD Warehouse. <br /> Facility receives bread from Goldstar, milk from Crystal, and produce from General Produce. <br /> The two 2 D Metro C200 warmers were out of order and not being used during the inspection. <br /> Discussed report with Leanna Nava. <br /> No signature captured. <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: DARIA AFONSKAIA Phone: (209)616-3035 <br /> FA0015582 PR0523085 SC101 04/11/2023 <br /> EHD 16-23 Rev.09/16/2020 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.sjgov.org/EHD <br />
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