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Time 1n:_320-am— <br /> Time <br /> 20am_Time Out: 10:20 am_ <br /> 4utM• San Joaquin County <br /> Environmental Health Department <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> rt Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.sigov.oralehd <br /> Food Program Service Request Inspection Report <br /> Name of Faci Le Y1A Date: 09/1612016 <br /> Address: 4932 PACIFIC AVE, STOCKTON 95207 <br /> Requestor: ARTHUR OSTROWSKI, NORR Telephone: (312)873-1067 <br /> Program Element: 1601 - FOOD PLAN CHECK Request#: SR0074224 <br /> inspection Type: 523- Plan Check/Report Review <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: Mark Siebert Expiration Data:September 30,2020 <br /> Warewash Chlorine(Cl): 50 ppm Heat: °F Water/Hot Water Ware Sink Temp: 120°F <br /> Quaternary Ammonia(QA): 200 ppm Hand Sink Temp: 105°F <br /> FOOD I --L C --TEMP°F--COMMENT <br /> 4 drawer prep—40.00°F 4 door prep--37.00°F <br /> walk in--41.00°F 4 drawer prep--40.00°F <br /> 1 door true—40.00°F 1 door true--41.00°F <br /> Ig walk in--41.00°F open case--35.00°F <br /> 4 drawer prep—40.00°F 2 door true--41.00°F <br /> 2 door true--41.00°F 1 door true--41.00°F <br /> 2 door true--41.00°F <br /> NOTES <br /> Ok to issue permit once fee is paid(check available0 <br /> Program 1626 Fee $368 for restaurant <br /> Pre final fee$139 <br /> Program 1919 Fee$254 for CO2 tank. Contact Lisa Medina for paper work <br /> Work on the following: <br /> 1.Provide food handier cards by 30 days <br /> 2.Provide for rest rooms soap, towels, toilet paper, and hand wash signs. <br /> Water heater 199,000 BTU <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: Mark Siebert, General Manager <br /> EH Specialist: MARIBEL FLOHRSCHUTZ Phone: (209) 953-7817 <br /> SR0074224 S0523 09!16)2016 <br /> EHD 1&23 Rev.06130±15 Page 1 of 1 Food Program Service Request Inspection Report <br />