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r SANJOAQUI Environmental Health Department <br /> -+ C U ( T Time In: 11:55 am <br /> }' Time Out: 12:16 pm <br /> G <br /> i�lFOSi4,k reatness grows here, <br /> Food Program Service Request Inspection Report <br /> Name of Facility: HICKORY FARMS LLC Date: 11/29/2022 <br /> Address: 269 SPRECKLES AVE , MANTECA 95336 <br /> Requestor: Telephone: <br /> Program Element: 1602-FOOD CONSULTATION Request#: SR0086098 <br /> Inspection Type: 061 -CONSULTATION <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 /> #21 Hot and Cold Potable Water Not Available <br /> OBSERVATIONS:Both rest rooms hand sinks have temp at 63F. Provide 100F or more today. <br /> CALCODE DESCRIPTION:An adequate,protected,pressurized,potable supply of hot water and cold water shall be provided at all times. <br /> (113953(c), 114099.2(b) 114101(a), 114189, 114192, 114192.1, 114195) <br /> #43 Toilet Facilites Clean/Supplied/Maintained <br /> OBSERVATIONS:Both rest rooms hand sinks have temporary soap bottles and paper rolls. Provide soap and paper towels <br /> from dispensers mounted to the walls in 1 week. <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 /> OVERALL INSPECTION NOTES AND COMMENTS <br /> OBSERVATIONS <br /> Name on Food Safety Certificate: N/A Expiration Date: <br /> Warewash Chlorine(Cl): ppm Heat: °F Water/Hot Water Ware Sink Temp: °F <br /> Quaternary Ammonia(QA): ppm Hand Sink Temp: °F <br /> FOOD ITEM--LOCATION--TEMP°F--COMMENTS <br /> No Temperature Data Collected <br /> NOTES <br /> Consultation inspection. <br /> Hickory Farms <br /> Prepackaged food only. No sampling on site. <br /> Okay to operate. <br /> Operating from Nov 23,2022 until Jan 5,2023. <br /> Obtain permit asap. <br /> PE1699 $55 to be paid for the new permit. <br /> Pink and green forms to be filled. <br /> SR0086098 SC061 11/29/2022 <br /> EHD 16-23 Rev.07/05/2022 Page 1 of 2 Food Program Service Request Inspection Report <br />