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Q�IN San Joaquin County <br /> 39 cOG <br /> Environmental Health Department <br /> _ 1868 East Hazelton Avenue, Stockton, CA95205-6232 <br /> .. ;p.. Telephone: (209)468-3420 Fax: (209)464-0138 Web:www.sjgov.org/ehd <br /> 9�/FO�� <br /> Food Program Official Inspection Report <br /> Facility Name and Address: COSTCO WHOLESALE#658, 3250 W GRANT LINE RD, TRACY 95377 <br /> OVERALL INSPECTION COMMENTS <br /> OBSERVATIONS <br /> Name on Food Safety Certificate: Expiration Date: <br /> Warewash Chlorine(Cl): ppm Heat: 9°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 /> No Temperature Data Collected <br /> NOT <br /> Sanitizer bucket-<150ppm quat—> 200ppm quat <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: Todd Jerman, Store Manager <br /> EH Specialist: MELISSA NISSIM Phone: (209) 468-3168 <br /> FA0014131 PR0518777 SC333 02/18/2015 <br /> EHD 16-23 Rev.01/30/15 Page 2 of 2 Food Program OIR <br />