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COMPLIANCE INFO_COMPLIANCE INFO 2015
Environmental Health - Public
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EHD Program Facility Records by Street Name
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LODI
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1600 - Food Program
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PR0160081
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COMPLIANCE INFO_COMPLIANCE INFO 2015
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Last modified
5/5/2020 8:58:04 AM
Creation date
5/5/2020 8:51:22 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
1600 - Food Program
File Section
COMPLIANCE INFO
FileName_PostFix
COMPLIANCE INFO 2015
RECORD_ID
PR0160081
PE
1624
FACILITY_ID
FA0001042
FACILITY_NAME
VILLAGE COFFEE SHOP INC
STREET_NUMBER
416
Direction
W
STREET_NAME
LODI
STREET_TYPE
AVE
City
LODI
Zip
95240
APN
04502047
CURRENT_STATUS
01
SITE_LOCATION
416 W LODI AVE
P_LOCATION
02
P_DISTRICT
004
QC Status
Approved
Scanner
JCastaneda
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EHD - Public
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°"Y;7-11 SAN JOAQUIN COU Y <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> _ = 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax: (209)464-0138 Web:www.sjgov.org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: /f J Date: <br /> V//((J�S <br /> Address: ' City: dl l Zip' Code: <br /> City: <br /> Telephone: <br /> Program Element: 4. Program Record: Off' `) L 41 Inspection Type: , n <br /> B180 Posted Yes ❑ Rermit Posted (�es ❑f Re-Inspection on or After: `C <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> ✓�c vlr�c .4(C C <br /> C-�E �.(,MVV, .{ t <br /> �c <br /> ti <br /> Item/Location Temperature Item F Location Temperature <br /> - ��� i <br /> ,ti 1y� r <br /> A 44ati-. 4 d4-0 l <br /> acility Hot Water Temperature War washing <br /> Name: n„ ,•nom Hand Sink: / ' of Chlorine: r ppm Heat: of <br /> Exp.Date: w C- arewashing Sink: d-kt of Quat.Amm.: v ppm Other: of <br /> Received By/Title: ; <br /> EH Specialist: Phone: <br /> Time in: Time Out: i O Page1of 7 <br /> EHD 16-24 (21'pg) 4,13/13 FOOD PROGRAM OIR CONTINUATION <br />
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