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1 1►I �OAQI I I AI Environmental Health Department <br /> COUNT -( IY <br /> ¢ �f flCri SS fGw3 I1BfE. Time In: 1020 am <br /> Op0,,`' Time Out: 12:10 pm <br /> Food Program Official Inspection Report <br /> Name of Facility: COSTCO WHOLESALE#658 Date: 12/09/2019 <br /> Address: 3250 W GRANT LINE RD, TRACY 95377 <br /> Owner/Operator: COSTCO WHOLESALE CORPORATION Telephone: (425)313-8100 <br /> Program Element: 1619-RETAIL MKT>1000 SQ FT(=/>2 DEPTS) <br /> Inspection Type: 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: Jeff Buftalmo Expiration Date:September 28,2022 <br /> Warewash Chlorine(Cl): ppm Heat: 160°F Water/Hot Water Ware Sink Temp: 120°F <br /> Quaternary Ammonia(QA): 200 ppm Hand Sink Temp: 100°F <br /> FOOD ITEM--LOCATION--TEMP°F--COMMENTS <br /> FA0014131 PR0518777 SCO01 12/09/2019 <br /> EHD 16-23 Rev.06/30/15 Page 1 of 3 Food Program OR <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br />