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r �I A (1111 Environmental Health Department <br /> CC)UNTY I <br /> Gf$oLIS@SSfwS hemTime In: 10.21 am <br /> Time Out: 10:47 am <br /> Food Program Official Inspection Report <br /> Name of Facility: MUSD-GEORGE Y KOMURE ELEMENTARY Date: 10/19/2021 <br /> Address: 2121 HENRY LONG BLVD, STOCKTON 95206 <br /> Owner/Operator: MANTECA UNIFIED SCHOOL DISTRICT Telephone: (209)825-3200 <br /> Program Element: 1632-EXEMPT FOOD <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: Nancy Serrano Expiration Date:September 16,2026 <br /> Warewash Chlorine(Cl): ppm Heat: °F Water/Hot Water Ware Sink Temp: 120°F <br /> Quaternary Ammonia(QA): ppm Hand Sink Temp: 100°F <br /> FOOD ITEM--LOCATION--TEMP°F--COMMENTS <br /> Norlake milk cooler-left cafeteria--41.00°F Norlake milk cooler-kitchen--44.00°F <br /> 2 door Traulsen-right--39.00°F restroom hand sink--117.00°F <br /> Norlake milk cooler-right cafeteria--37.00°F burrito at hot hold--143.00°F <br /> hot dog at hot hold--137.00°F 2 door Traulsen-left--41.00°F <br /> walk-in cooler--39.00°F <br /> NOTES <br /> wiping cloth bucket 200 ppm Cl/chlorine sanitizer test strips are available <br /> Lunch is served 10:50am-12:50pm <br /> Additional FSC: Fazillat Khan-expires 1-30-2025&Victoria Nieves-expires 12-4-2024 <br /> Hot food is transported in from Weston Ranch High School (arrives around 10am) <br /> No signature obtained <br /> Report typed in the office 1:17pm-1:25pm <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/Nancy Serrano, NSL <br /> EH Specialist: KADEANNE LINHARES Phone: (209)616-3025 <br /> FA0014810 PR0521810 SCO01 10/19/2021 <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 />