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Time In: 1020 am <br /> Time Out: 10:55 am <br /> op.. .. San Joaquin County <br /> Environmental Health Department <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • �... _ P• Telephone: (209)468-3420 Fax:(209)464-0138 Web:www.sigov.org/ehd <br /> 4�IFO'Rt� <br /> Food Program Official Inspection Report <br /> Name of Facility: LODI USD-ANSEL ADAMS ELEMENTARY Date: 04/11/2016 <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: Mary Petterson Expiration Date:June 02,2020 <br /> Warewash Chlorine(Cl): ppm Heat: 160°F Water/Hot Water Ware Sink Temp: 128°F <br /> Quaternary Ammonia(QA): ppm Hand Sink Temp: 100°F <br /> FOOD ITEM--LOCATION--TEMP°F--COMMENTS <br /> Walk In--kitchen--37.00°F HW--kitchen--100.00°F <br /> prep--kitchen--123.00°F Bev Air milkbox right--gym--44.00°F <br /> RR employee- 100.00°F Bev Air milkbox left--gym--37.00°F <br /> sprayer--kitchen--120.00°F Metro c200--kitchen--186.00°F <br /> 3-comp- kitchen 128.00°F 2D Cres Cor--gym--170.00°F <br /> Metro c200--gym 171.00°F <br /> NOTES <br /> Sanitizer bucket 200 ppm quat <br /> No violation noted. <br /> Notes: <br /> -Only one thermo test strip left. Recommend provide more soon. <br /> -Tested warewasher using facility thermo strip. Provided back to facility. <br /> Copy of report will be emailed to mpatterson@lodiusd.net and Cindy Oliver <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: matt me daniels, lunch duty <br /> EH Specialist: JEFFREY WONG Phone: (209)468-0335 <br /> FA0015582 PRO523085 SC101 04/11/2016 <br /> EHD 16-23 Rev.06/30/15 Page 1 of 1 Food Program OIR <br />