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° ur I Environmental Health Department <br /> SAN-6-JOAQU <br /> Greotness grows here. <br /> Food Program Service Request Inspection Report <br /> Facility Name and Address: PACIFIC AVENUE CHEVRON, 6633 PACIFIC AVE , STOCKTON 95207 <br /> #41 Plumbing Maintained;Approved Back Flow Device <br /> OBSERVATIONS:Pipe, draining the 3 comp sink in the underneath floor sink, is lacking air gap. Provide air gap at least 1 <br /> inch off the floor sink in 1 week. <br /> 3 comp sink has a loose water faucet. Secure faucet in 1 week. <br /> CALCODE DESCRIPTION:The potable water supply shall be protected with a backflow or back siphonage protection device,as required <br /> by applicable plumbing codes. (114192)All plumbing and plumbing fixtures shall be installed in compliance with local plumbing <br /> ordinances, shall be maintained so as to prevent any contamination,and shall be kept clean,fully operative,and in good repair. Any hose <br /> used for conveying potable water shall be of approved materials,labeled,properly stored,and used for no other purpose. (114171, <br /> 114189.1, 114190, 114193, 114193.1, 114199, 114201, 114269) <br /> #43 Toilet Facilites Clean/Supplied/Maintained <br /> OBSERVATIONS:Employee rest room hand sink is lacking paper towels and customer rest room hand sink is lacking <br /> soap. Provide soap and paper towels from dispensers in 1 week. In the mean time facility uses temporary soap bottle with <br /> pump and temporary paper roll. <br /> CALCODE DESCRIPTION:Toilet facilities shall be maintained clean, sanitary and in good repair. Toilet rooms shall be separated by a <br /> well-fitting self-closing door. Toilet tissue shall be provided in a permanently installed dispenser at each toilet. The number of toilet <br /> facilities shall be in accordance with local building and plumbing ordinances. Toilet facilities shall be provided for patrons:in <br /> establishments with more than 20,000 sq ft. establishments offering on-site liquor consumption. (114250, 114250.1, 114276) <br /> #45 Floors,Walls, Ceilings; Clean and Maintained <br /> OBSERVATIONS:Floor of the walk in cooler has debris. Clean floor today. <br /> CALCODE DESCRIPTION:The walls/ceilings shall have durable,smooth,nonabsorbent,light-colored,and washable surfaces. All floor <br /> surfaces, other than the customer service areas, shall be approved, smooth, durable and made of nonabsorbent material that is easily <br /> cleanable.Approved base coving shall be provided in all areas,except customer service areas and where food is stored in original <br /> unopened containers. Food facilities shall be fully enclosed. All food facilities shall be kept clean and in good repair. (114143(d), <br /> 114266, 114268, 114268.1, 114271, 114272) <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: 117°F <br /> Quaternary Ammonia(QA): 300 ppm Hand Sink Temp: 116°F <br /> FOOD ITEM--LOCATION--TEMP°F--COMMENTS <br /> 2 D Bev Air cooler/sandwiches--Retail--39.00°F Mop sink--116.00°F <br /> Walk in cooler--35.00°F Sandwiches--Food warmer--141.00°F <br /> 1 CO2 tank--137.000 L More than 137LBS Hand sink Women rest room--110.00°F <br /> Hot dog--Hot dog roller 174.00°F Hand sink--Men rest room--111.00°F <br /> NOTES <br /> Change of ownership. <br /> FA0002483 SR0084751 SC061 01/24/2022 <br /> EHD 16-23 Rev.09/16/2020 Page 2 of 3 Food Program Service Request Inspection Report <br />