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Environmental Health Department <br />Facility Name and Address: DOLLAR GENERAL # 15928, 12984 BLOSSOM Ct, LOCKEFORD 95237 <br />Food Program Official Inspection Report <br />Chlorine (Cl): <br />Name on Food Safety Certificate:Expiration Date: <br />ppmQuaternary Ammonia (QA): <br />Heat:ppm º FWarewash Water/Hot Water Ware Sink Temp:º F <br />Hand Sink Temp:º F <br />OBSERVATIONS <br />OVERALL INSPECTION NOTES AND COMMENTS <br />hand sink -- right restroom -- 100.00º F 2 dr True dairy -- market, near pet food -- 40.00º F <br />hand sink -- left restroom -- 100.00º F mop sink -- back room -- 120.00º F <br />3 dr True fresh food/milk -- market -- 41.00º F 2 dr True fresh food/deli -- market -- 41.00º F <br />FOOD ITEM -- LOCATION -- TEMP º F -- COMMENTS <br />NOTES <br />Routine inspection. <br />Prepackaged food only. <br />Discussed report with Kayla Crawford, Assistant Store Manager. <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:Phone:(209) 616-3035 <br />, <br />DARIA AFONSKAIA <br />Page 2 of 2EHD 16-23 Rev. 09/16/2020 Food Program OIR <br />FA0023094 PR0540417 SC001 11/15/2021 <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjgov.org/EHD