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SAN J 0 A Q U I N Environmental Health Department <br /> CC)U NTY <br /> Food Program Official Inspection Report <br /> Facility Name and Address: DOLLAR GENERAL# 15928, 12984 BLOSSOM Ct, LOCKEFORD 95237 <br /> OVERALL INSPECTION NOTES AND COMMENTS <br /> OBSERVATIONS <br /> Name on Food Safety Certificate: Expiration Date: <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 /> Mop Sink--Back Room--120.00°F 3-Door True/Milk--Market--41.00°F <br /> Hand Sink--Restroom 2--100.00°F 2-Door True/Ham--Market--41.00°F <br /> Hand Sink--Restroom 1 --100.00°F <br /> NOTES <br /> Routine inspection conducted this date,the followings were noted: <br /> Prepackaged food only. <br /> Inspection report was discussed with Dominque Delatorre,Assistant Manager. Signature not captured. <br /> Inspection report will be e-mailed to facility. <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: <br /> EH Specialist: STEVEN SHIH Phone: (209)468-3420 <br /> FA0023094 PR0540417 SCO01 08/26/2020 <br /> EHD 16-23 Rev.08/10/2020 Page 2 of 2 Food Program OIR <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjgov.org/EHD <br />