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`'.. ll � � �A�] I N Environmental Health Department <br /> `- Irl +lJ <br /> L.. v•:v COUNTY <br /> 7fa�p[r+85S growshere. Time In: 9.30 am <br /> Time Out: 10:24 am <br /> Food Program Official Inspection Report <br /> Name of Facility: SUSD-GEORGE BUSH ELEMENTARY SCHOOL Date: 10/28/2021 <br /> Address: 5420 FRED RUSSO DR, STOCKTON 95212 <br /> Owner/Operator: STOCKTON UNIFIED SCHOOL DIST Telephone: (209)933-7045 <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: Sherrill Fullter Expiration Date: February 24,2022 <br /> Warewash Chlorine(Cl): ppm Heat: °F Water/Hot Water Ware Sink Temp: 121 °F <br /> Quaternary Ammonia(QA): 300 ppm Hand Sink Temp: 100°F <br /> FOOD ITEM--LOCATION--TEMP°F--COMMENTS <br /> Traulsen milk cooler--cafeteria--41.00°F Beverage Air milk cooler--cafeteria--40.00°F <br /> Norlake milk cooler--cafeteria--41.00°F 2 dr Traulsen--kitchen,right--37.00°F <br /> 2 dr Crescor warmer--kitchen--141.00°F 2 dr Aquatemp warmer--kitchen--155.00°F <br /> hand sink--female restroom--100.00°F hand sink--male restroom--100.00°F <br /> 2 dr Traulsen--kitchen,left--38.00°F prep sink--120.00°F <br /> NOTES <br /> Routine inspection. <br /> Currently cafeteria is only warming up premade/packaged food items. <br /> Facility serves breakfast from 7:15-8:15 AM and lunch from 10:00 AM- 12:30 PM. <br /> Facility receives food items from Stockton Unified School District Warehouse and Goldstar. <br /> Facility receives produce from Daylight and ProPacific. <br /> Facility receives bread from Bimbo and milk from Crystal. <br /> Provide 1 in. minimum air gap between spaghetti kettle discharge pipe and floor sink prior to using it again. <br /> Report discussed with Sherrill Fuller. <br /> No signature captured. <br /> Maintain a copy of this report on site. <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: DARIA AFONSKAIA Phone: (209)616-3035 <br /> FA0017872 PR0526416 SCO01 10/28/2021 <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 />