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Pa�'y 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 /> ��/FORa <br /> Food Program Service Request Inspection Report <br /> Facility Name and Address: HOLLYWOOD VIDEO#005522, 265 W LOUISE AVE , MANTECA 95336 <br /> OVERALL INSPECTION NOTES AND COMMENTS <br /> OBSERVATIONS <br /> Name on Food Safety Certificate: Expiration Date: <br /> Warewash Chlorine(Cl): 100 ppm Heat: °F Water/Hot Water Ware Sink Temp: 148°F <br /> Quaternary Ammonia(QA): ppm Hand Sink Temp: 120°F <br /> FOOD ITEM--LOCATION--TEMP°F--COMMENTS <br /> men's restroom hand sink--100.00°F 1 comp prep sink--120.00°F <br /> 2 door prep--40.00°F 3 comp sink--148.00°F <br /> mop sink--120.00°F kitchen hand sink#2--120.00°F <br /> walk-in cooler--40.00°F kitchen hand sink#1 --120.00°F <br /> women's restroom hand sink--100.00°F <br /> NOTES <br /> Chlorine test strips available <br /> Additional equipment:walk-in freezer, 2 drawer freezer, ice cream chest freezer. <br /> Hot water heater: Richmond 75,100 BTU 72.8 gallon <br /> Final inspection conducted. OK to permit as a 1626 once annual permit fee is paid. <br /> Return to 1868 E. Hazelton Ave. in Stockton to pay the annual permit fee of$368 prior to opening to the public. <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: ll Name and Title: Fatima Arroyo, Manager <br /> EH Specialist: KADEANNE LINHARES Phone: (209)468-0330 <br /> FA0012187 SR0073887 SC523 09/09/2016 <br /> EHD 16-23 Rev.06/30/15 Page 2 of 2 Food Program Service Request Inspection Report <br />