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Time In: 11-47 am <br /> Time Out: 12:19 pm <br /> �P.Q•u��.. P San Joaquin County <br /> y� 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.org/ehd <br /> '9Gl P Oftt� <br /> Food Program Official Inspection Report <br /> Name of Facility: ACACIA MIDDLE CHARTER SCHOOL Date: 04/20/2016 <br /> Address: 1605 E MARCH LN, STOCKTON 95210 <br /> Owner/Operator: LYSCO, LYNN Telephone: (209)477-7014 <br /> Program Element: 1632-EXEMPT FOOD <br /> Inspection Type: ROUTINE INSPECTION -Operating Permit <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 /> #41 Plumbing Maintained;Approved Back Flow Device <br /> OBSERVATIONS:No anti-siphon on mop sink faucet with hose attached. Provide approved back flow device(i.e., <br /> anti-siphon, air gap, hose bib, reduced pressure, etc.)in 2 weeks. <br /> CALCODE DESCRIPTION:The potable water supply shall be protected with a backflow or back siphonage protection device,as required <br /> by applicable plumbing codes. (114192)All plumbing and plumbing fixtures shall be installed in compliance with local plumbing <br /> ordinances, shall be maintained so as to prevent any contamination,and shall be kept clean,fully operative,and in good repair. Any hose <br /> used for conveying potable water shall be of approved materials,labeled,properly stored,and used for no other purpose. (114171, <br /> 114189.1, 114190, 114193, 114193.1, 114199, 114201, 114269) <br /> OVERALL INSPECTION NOTES AND COMMENTS <br /> OBSERVATIONS <br /> Name on Food Safety Certificate: Veronica Huerta Expiration Date: March 29,2019 <br /> Warewash Chlorine(Cl): 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 /> Revolution Foods--146.00°F RR staff(food handlers)--100.00°F <br /> True milkbox--42.00°F 2D True--41.00°F <br /> RR staff(not for food handlers)--69.00°F mop sink--120.00°F <br /> NOTES <br /> No violations noted: <br /> Notes: <br /> Facility has provided sneeze guard for self-service table <br /> Food prepackaged from Revoultion in Oakland. All utensil washing is done in Oakland. <br /> Front staff restrooms do not have 100-108 F; use only the staff restroom at back where hot water is available 100-108F. <br /> OIR will be emailed to gdavis@acaciamiddle.org and reubling@lvcs.org <br /> FA0023385 PR0540887 SCO01 04/20/2016 <br /> EHD 16-23 Rev.06/30/15 Page 1 of 2 Food Program OIR <br />