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Time In: 11:20 am <br /> Time Out: 11:55 am <br /> San Joaquin County <br /> Environmental Health Department <br /> W. <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Y.. Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.sjgov.orq/ehd <br /> 4�iFoa�a� <br /> Food Program Service Request Inspection Report <br /> Name of Facility: HICKORY FARMS#13718 Date: 11/05/2015 <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#: SR0073435 <br /> Inspection Type: 061 -CONSULTATION r - 91 `7 <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 T <br /> 113700.All violations must be corrected within specified timeframe. Violations that are classed as"MAJOR"pose an immediate threat to public health <br /> and have the potential to cause foodbome 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: Jennifer DEigan Expiration Date: October 18,2018 <br /> Warewash Chlorine(Cl): ppm Heat: °F Water/Hot Water Ware Sink Temp: °F <br /> Quaternary Ammonia(QA): ppm Hand Sink Temp: 106 OF <br /> FOOD ITEM --LOCATION --TEMP°F--COMMENTS <br /> Freezer--customer area--21.00°F <br /> NOTES <br /> All non potentially hazardous samples shall be dispensed from bottles into disposable cups. <br /> Potentially hazardous samples shall be cut up with disposable utensils and given away by 4 hours. <br /> Keep potentially hazardous foods(cheese) at 45 F or lower at all times. <br /> OK to issue permit <br /> Food handler Netanya Smith Exp 11-03-18 <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: Jennifer Deigan Area Manager <br /> EH Specialist: MARIBEL FLOHRSCHUTZ Phone: (209) 953-7817 <br /> FA0002706 SR0073435 SC061 1V05/2015 <br /> EHD 16-23 Rev.06/30/15 Page 1 of 1 Food Program Service Request Inspection Report <br />