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r MJOA(1111 Environmental Health Department <br /> COUNTY I <br /> Gf$oLn@SSfwS hemTimeln: 11-16am <br /> Time Out: 11:35 am <br /> Food Program Official Inspection Report <br /> Name of Facility: TRACY USD-JACOBSON SCHOOL Date: 03/16/2021 <br /> Address: 1750 W KAVANAGH AVE, TRACY 95376 <br /> Owner/Operator: TRACY UNIFIED SCHOOL DISTRICT Telephone: (209)830-3200 <br /> Program Element: 1632-EXEMPT FOOD <br /> Inspection Type: ROUTINE INSPECTION (Chargeable) <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: Geraldine Knoernschild Expiration Date:October 22,2023 <br /> Warewash Chlorine(Cl): ppm Heat: °F Water/Hot Water Ware Sink Temp: 120°F <br /> Quaternary Ammonia(QA): 400 ppm Hand Sink Temp: 120°F <br /> FOOD ITEM--LOCATION--TEMP°F--COMMENTS <br /> True milk cooler#2--41.00°F 2 door True--40.00°F <br /> chicken @ line--136.00°F--portioning into"to-go"boxes CresCor warmer--137.00°F <br /> rice/mixed vegetables @ line--154.00°F--portioning into"to-go" True milk cooler--38.00°F <br /> boxes <br /> NOTES <br /> wiping cloths @ 3-comp sink 400 ppm Quat/Quat sanitizer test strips are available <br /> Food is received from West High School-arrives prior to staff being on site at 10:15am <br /> Food is currently being distributed to students in the cafeteria (bagged)between 11:30a-12:30p <br /> Students are due back on campus March 22, 2021 <br /> No signature obtained/COVID-19 <br /> Report typed at the office 3:33-3:42pm <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: Discussed w/Geraldine K, FSW <br /> EH Specialist: KADEANNE LINHARES Phone: (209)616-3025 <br /> FA0002968 PRO162579 SC101 03/16/2021 <br /> EHD 16-23 Rev.09/16/2020 Page 1 of 1 Food Program OR <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 />