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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: SUPER FISH POKE&TEA, 5052 WEST LN, STOCKTON 95210 <br /> OVERALL INSPECTION NOTES AND COMMENTS <br /> OBSERVATIONS <br /> Name on Food Safety Certificate: required Expiration Date: <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 /> hand sink--back area--100.00°F prep sink--back area--120.00°F <br /> hand sink--restroom--100.00°F 2 dr Turbo Air upright cooler--back area--35.00°F <br /> 2 dr True reach-in w/prep top--front counter--38.00°F hand sink--front counter--100.00°F <br /> mop sink--129.00°F 3 comp sink--back area--129.00°F <br /> NOTES <br /> Name changed to Tiger Milk Boba. <br /> Provided 5021 form to Manager. <br /> Quat test strips available. <br /> Discussed report with manager. <br /> No signature captured. <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: Aaron Joshua Ramsey, Manager <br /> EH Specialist: DARIA AFONSKAIA Phone: (209)616-3035 <br /> FA0024324 PR0542341 SCO01 09/07/2021 <br /> EHD 16-23 Rev.09/16/2020 Page 4 of 4 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 />