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S A N J O a Q U I N Environmental Health Department <br /> — C 0 j :V y <br /> Mobile Food Facility Official Inspection Report <br /> Facility Name and Address: ICE CREAM STORE, 14900 W HWY 12 , LODI 95242 <br /> OVERALL INSPECTION NOTES AND COMMENTS <br /> OBSERVATIONS <br /> Name on Food Safety Certificate: Expiration Date: <br /> Warewash Chlorine(Cl): ppm Heat: °F Water/Hot Water Ware Sink Temp: 131 °F <br /> Quaternary Ammonia(QA): ppm Hand Sink Temp: 100°F <br /> FOOD ITEM--LOCATION--TEMP°F--COMMENTS <br /> 1 D Avantco reach-in--43.00°F nonadjustable hand sinks women's restroom--106.00°F- <br /> range 105-108 F <br /> hand sink--shack--100.00°F nonadjustable hand sinks men's restroom--104.00°F--randge <br /> 101-108 <br /> 3 comp sink--131.00°F <br /> NOTES <br /> Routine inspection. <br /> Facility will serve shaved ice, popcorn, and bottled drinks only. <br /> Provide 41 F or below prior to storing any PHFs in 1 D Avantco reach-in. <br /> Discussed report with Kathy DeGoede,Assistant general manager. <br /> No signature captured. <br /> Ok to issue permit once fee is paid. <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: DARIA AFONSKAIA Phone: (209)616-3035 <br /> FA0006879 PR0544531 SCO01 05/05/2023 <br /> EHD 16-23 Rev.09/16/2020 Page 2 of 2 Mobile Food Facility OIR <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjgov.org/EHD <br />