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COMPLIANCE INFO
Environmental Health - Public
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EHD Program Facility Records by Street Name
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1600 - Food Program
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PR0516336
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COMPLIANCE INFO
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Entry Properties
Last modified
5/22/2020 1:48:33 PM
Creation date
4/9/2020 9:07:15 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
1600 - Food Program
File Section
COMPLIANCE INFO
RECORD_ID
PR0516336
PE
1615
FACILITY_ID
FA0012563
FACILITY_NAME
Ross Dress For Less #0477
STREET_NUMBER
340
Direction
W
STREET_NAME
KETTLEMAN
STREET_TYPE
Ln
City
Lodi
Zip
95240
CURRENT_STATUS
01
SITE_LOCATION
340 W Kettleman Ln
P_LOCATION
02
P_DISTRICT
004
QC Status
Approved
Scanner
JCastaneda
Tags
EHD - Public
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O.Paq!N�QOSAN JOAQUIN COUNT Y <br /> ) . G <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> J. 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • C'q... - a�P Telephone: (209) 468-3420 Fax: (209)464-0138 Web:www.sjgov.org/ehd <br /> <<koR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Si+sgec- # Date: _Z _ <br /> Address: 4,,C KCft1-PMa City. Loa i Zip Code: 9_5Z44O <br /> Owner/Operator: fps Telephone: 36 _ '3Q <br /> Program Element: 2 Program Record: ! Inspection Type: 12-0LA <br /> SB180 Posted 'Yes ❑ No Permit Posted TkYes ❑ No c� Re-Inspection on or After: <br /> B ERVATIONS AN®_CORRECTIVE ACTIONS <br /> / <br /> The- 4` r- CWer/n lin !°11 I' ('odwN i's da Rh <br /> C�rVI I ' P KC H.0 <br /> Name: Hand Sink: C)(D t 'F hlorine: ppm Heat: JF <br /> Exp.Date: arewashing SC: I Z of uat.Amm.: ppmOther: <br /> Received By/Title: d /1' <br /> i a ( <br /> EH Specialist: Phon 6 _ If q4;,— <br /> Time in: , Time Out: , r� PageZof <br /> EHD 16-24 (2n1 pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />
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