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f ,... SA N J QA Q U I N Environmental Health Department <br /> " J W' � --.---CQUNT " <br /> +i r (7,r t 5 5 g r o,, ` - <br /> Mobile Food Facility Service Request Inspection Report <br /> Facility Name and Address: RISE &SHINE COFFEE, 355 N GUILD AVE , LODI <br /> OBSERVATIONS <br /> Name on Food Safety certificate Needed Expiration Date: <br /> Warewash Chlorine(CI): ppm Heat: °F Water/Hot Water Ware Sink Temp: °F <br /> Quaternary Ammonia(QA): ppm Hand Sink Temp: °F <br /> FOOD ITEM—LOCATION--TEMP°F—COMMENTS <br /> One door LG cooler—40°Fahrenheit <br /> NOTES <br /> Consultation inspection for new CMFO. No major violations. No re-inspection. <br /> Ok to issue permit once permit fee is paid and green sheet is received. <br /> PE 1633 <br /> License#YE2442 <br /> VIN#36932 <br /> Official inspection report was hand delivered to operator. <br /> To minimize person-to-person contact,the signature of the person receiving the inspection report was not captured. <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: LYDIA BAKER Phone: 209 616-3046 - <br /> AP2502721 SC521 10103/2025 <br /> FHP 16-23 Rev.09/16/2020 Page 2 of 2 MoMe Food Facility Service Request Inspection Report <br />