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Time In: 1-25 prn <br /> Time Out: 2:101)m <br /> �.... .. 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: HICKORY FARMS#13718 Date: 11/06/2017 <br /> Address: 4950 PACIFIC AVE , STOCKTON 95207 <br /> Requestor: JEFF IBACH, HICKORY FARMS#13718 Telephone: (419)725-9336 <br /> Program Element: 1699-TEMPORARY INCIDENTAL FOOD Request#: SR0077987 <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: 140°F <br /> FOOD ITEM--LOCATION--TEMP°F--COMMENTS <br /> freezer--sales--31.00°F <br /> NOTES <br /> ok to issue permit. It will be mailed to billing address <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 /> - --- <br /> Received by: Name and Title: antoinette guardado, sales <br /> EH Specialist: MARIBEL FLOHRSCHUTZ Phone: (209)953-7817 <br /> FA0002706 SR0077987 SC061 11/06/2017 <br /> EHD 16-23 Rev.06/30/15 Page 1 of 1 Food Program Service Request Inspection Report <br />