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SAN u A U N Environmental Health Department <br /> COUNTY <br /> vrrutnf ss Zrowc ,f, <br /> Food Program Service Request Inspection Report <br /> Name of Facility: Date: 07/08/2025 <br /> Address: 1110 W KETTLEMAN LN , LODI 95240 <br /> Requestor. Telephone: (}- <br /> Program Element: - Request#: SR2501218 <br /> inspection Type: 2160-Field Activity/Other inspection <br /> VIOLATIONS AND CORRECTIVE ACTIONS <br /> Items listed on this report as violations do not meet the requirements set forth in the California Heatth and Safety Code commencing with section 7: <br /> 113700.All viotabons must be corrected within specified timeframe. Violations that are dassified 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 <br /> OVERALL INSPECTION NOTES AND COMMENTS <br /> OBSERVATIONS <br /> Name on Food Safety Certificate Itzcoatl Friaz Expiration Dated/2512030 <br /> Warewash Chlorine(Cl): ppm Heat: „F water/Hot Water Ware Sink Temp: 129 °F <br /> Quaternary Ammonia(QA) ppm Hand Sink Temp: 106 o F <br /> FOOD ITEM--LOCATION—TEMP'F—COMMENTS <br /> 3 comp sink—129°Fahrenheit hand sink—106°Fahrenheit <br /> hand sink—Men's restroom—103°Fahrenheit hand sink—Women's restroom— 130'Fahrenheit <br /> NOTES <br /> Change of owner. <br /> PE 1612 <br /> OK to issue permit once permit fee is paid and 5021 form is completed. <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: FRANCISCO RUIZ Phone: (209)616-3032 <br /> SR2501218 SC2160 071082025 <br /> EHD 16-23 Rev.091162020 Page 1 of 1 Food Program Service Request Inspection Report <br /> plz 0 S 2_1q - <br />