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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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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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SAN JOAQUIN COON <br /> � •.OG <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax: (209)464-0138 Web:www.sigov.org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: t . Date: <br /> 5- <br /> Address: '4/(,, P- <br /> 1'6w, j City: / Zip Code: <br /> Owner/Operator: ?U VU4,_-A�Ct -5Ukl Telephone: <br /> Program Element: / C) 2 _ Program Record: �� , 3 Inspection Type: <br /> 8180 Posted ❑Yes ❑ Rermit Posted ❑Yes ❑1 Re-Inspection on or After: T� <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> f (� (_� ���- a-_ ccS �� cz d� -�,_e e.-� tom.- ; •� ,. :;.1 .;<`� ; : ! <br /> Temperature Item t Location Temperature <br /> r>w,r- <br /> 3VF -,,e oar- 2erAA- l�H of r <br /> ter- 4I >u,ll�_2 ��,s�r� - „� <Ck �II.'(z' <br /> Facility Hot WaterTemperature Warewashing <br /> Name: K ; SQ1 Hand Sink: 100 of Chlorine: ppm Heat: of <br /> Exp.Date: _ _ arewashing Sink: i Z v 11' of Quat.Amm.: ppm Other: of <br /> Received By/Title: <br /> EH Specialist: Ai ) Phone: y6� •3 ear <br /> �•K Time Out: Paof <br /> Time in: I fl :O� Page� <br /> EHD 16-24(2nd pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />
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