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Environmental Health Department <br /> SAN-6-JOAQUIN <br /> �M COUNTY <br /> r'�JFOSx'tYY r Greotness grows here. <br /> Mobile Food Facility Service Request Inspection Report <br /> Facility Name and Address: LA POBLANITA, 320 E LODI AVE , LODI <br /> OBSERVATIONS <br /> Name on Food Safety Certificate: Needed Expiration Date: <br /> Warewash Chlorine(Cl): ppm Heat: °F Water/Hot Water Ware Sink Temp: 120°F <br /> Quaternary Ammonia(QA): ppm Hand Sink Temp: 100°F <br /> FOOD ITEM--LOCATION--TEMP°F--COMMENTS <br /> Atosa 1-dr freezer--0.00°F Steam table--146.00°F <br /> Atosa 1-dr upright cooler--39.00°F Atosa 1-dr prep cooler--39.00°F <br /> NOTES <br /> No major violations. <br /> Chlorine bleach for sanitizing and test trips on site. <br /> Not okay to issue permit until the following is received: <br /> -Commissary Agreement <br /> -Facility forms(pink and green) <br /> LIC: 8J24416 <br /> VIN: ******05989 <br /> Note: The signature of the person receiving the inspection report was not captured during the inspection. <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: CLAUDIA MURO Phone: (209)561-8923 <br /> SR0087214 SC061 10/13/2023 <br /> EHD 16-23 Rev.07/05/2022 Page 2 of 2 Mobile Food Facility Service Request Inspection Report <br />