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Time In: 11.10 am <br /> Time Out: 12:04 pm <br /> �P"O.WN' P San Joaquin County <br /> .X Environmental Health Department <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • �•.• �P Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.sigov.orq/ehd <br /> '9C%FORM <br /> Food Program Service Request Inspection Report <br /> Name of Facility: ACACIA MIDDLE CHARTER SCHOOL Date: 03/30/2016 <br /> Address: 1605 E MARCH LN , STOCKTON 95210 <br /> Requestor: RACHEL EUBLING,TRI VALLEY LEARNING CORP Telephone: (925)997-1183 <br /> Program Element: 1602-FOOD CONSULTATION Request#: SR0074452 <br /> Inspection Type: 061 -CONSULTATION <br /> VIOLATIONS AND CORRECTIVE ACTIONS <br /> Items listed on this report as violations do not meet the requirements set forth in the California Health and Safety Code commencing with section 7; <br /> 113700.All violations must be corrected within specified timeframe. Violations that are classified as"MAJOR"pose an immediate threat to public health <br /> and have the potential to cause foodborne illness.All major violations must be corrected immediately.Non-compliance may warrant immediate closure of <br /> the food facility. <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: °F <br /> Quaternary Ammonia(QA): ppm Hand Sink Temp: 106°F <br /> FOOD ITEM--LOCATION--TEMP°F--COMMENTS <br /> Milk box 39.00°F 2d True--40.00°F <br /> Restroom--106.00°F <br /> NOTES <br /> Facility receives prepackaged food from Revolution Foods(8383 Capwell Dr., Oakland, 510-596-9024)at 41 F daily. Food is <br /> brought in dalLY to the student cafe with laminated tile floor and rubber baseboard (withchardening coat)for storage, some of <br /> which require reheating before serving. Food is then before placing on table for self-service by students, including use of <br /> tongs, or scoops for items such as salad. Otherwise all food are prepackaged. Serving utensils like tongs are provided by <br /> Revolution daily and returned to Revolution the following day for washing at their facility in Oakland, and all eating utensils are <br /> disposable. No ware-washing on site. <br /> Provide: <br /> -Sneeze guard for self-serve food and cover for utensils in 3 days <br /> -Food Manager Safety certification within 60 days <br /> -Holes and gaps on baseboard. Repair. Recommend using epoxy. <br /> OK to issue permit after fee is paid. PE 1632 <br /> Report will be emailed to reubling@lvcs.org <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 /> 4� <br /> Received by: Name and Title: Rachel Eubling, Compliance Manage <br /> EH Specialist: JEFFREY WONG Phone: (209)468-0335 <br /> SR0074452 SC061 03/30/2016 <br /> EHD 16-23 Rev.06/30/15 Page 1 of 1 Food Program Service Request Inspection Report <br />