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San Joaquin County <br /> 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 /> QLtkoR�'� <br /> Food Program Service Request Inspection Report <br /> Facility Name and Address: RIDE209, 1475 MOFFAT BLVD , MANTECA <br /> #41 Plumbing Maintained;Approved Back Flow Device <br /> OBSERVATIONS:Plumb the waste line of the ice machine by means of indirect connection (to the floor sink)prior to <br /> operation. <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 /> #43 Toilet Facilites Clean/Supplied/Maintained <br /> OBSERVATIONS:Fill the toilet paper dispensers prior to operation. <br /> CALCODE DESCRIPTION:Toilet facilities shall be maintained clean, sanitary and in good repair. Toilet rooms shall be separated by a <br /> well-fitting self-closing door. Toilet tissue shall be provided in a permanently installed dispenser at each toilet. The number of toilet <br /> facilities shall be in accordance with local building and plumbing ordinances. Toilet facilities shall be provided for patrons:in <br /> establishments with more than 20,000 sq ft. establishments offering on-site liquor consumption. (114250, 114250.1, 114276) <br /> OVERALL INSPECTION NOTES AND COMMENTS <br /> OBSERVATIONS <br /> Name on Food Safety Certificate: Michele Petlansky Expiration Date:April 07,2022 <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 /> 1 door Atosa--right uunit--39.00°F 1 door Atosa--left unit--37.00°F <br /> Turbo Air--freezer--16.00°F 1 door Avantco--390.00°F <br /> NOTES <br /> pre-final inspection <br /> Facility will do Herbalife, acai bowls, and will sell pre-made meals(Valley Meal Prep). <br /> Call inspector when ready for a final inspection. <br /> OK to permit will not be issued until hot water is obtained. <br /> Final inspection maybe Tuesday 1-16-18/inspector will call to schedule <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: Michele Petlansky, owner <br /> EH Specialist: KADEANNE LINHARES Phone: (209)468-0330 <br /> SR0077262 SC523 01/10/2018 <br /> EHD 16-23 Rev.06/30/15 Page 2 of 2 Food Program Service Request Inspection Report <br />