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Time In: 10-50 am <br /> Time Out: 11:25 am <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.org/ehd <br /> '9C%FORM <br /> Food Program Service Request Inspection Report <br /> Name of Facility: HICKORY FARMS#13718 Date: 11/04/2016 <br /> Address: 4950 PACIFIC AVE , STOCKTON 95207 <br /> Requestor: JENNY MORRISON, HICKORY FARMS#13718 Telephone: (209)518-6822 <br /> Program Element: 1602-FOOD CONSULTATION Request#: SR0075477 <br /> Inspection Type: 001 -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 /> 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: 110°F <br /> FOOD ITEM--LOCATION--TEMP°F--COMMENTS <br /> large freezer--back--48.00°F small freezer--front--40.00°F <br /> NOTES <br /> ok to start sales <br /> Work on the following <br /> 1. Keep potentially hazardous foods at 41 F or lower(provide a tight lid for freezers) <br /> 2.Use disposable utensils and toothpicks for samples <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: randi de la nuez, area manager <br /> EH Specialist: MARIBEL FLOHRSCHUTZ Phone: (209)953-7817 <br /> FA0002706 SR0075477 SCO01 11/04/2016 <br /> EHD 16-23 Rev.06/30/15 Page 1 of 1 Food Program Service Request Inspection Report <br />