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Environmental Health Department <br />Time In: <br /> 1:30 pm <br /> 1:00 pm <br />Time Out: <br />Program Element: 1618 - RETAIL MKT >2000 SQ FT (PREPKGD / LTD PREP) <br />Telephone: (615) 855-4024 Owner/Operator: DOLGEN CALIFORNIA LLC <br />Inspection Type: ROUTINE INSPECTION - Operating Permit <br />Address: 12984 BLOSSOM Ct, LOCKEFORD 95237 <br />Date: 01/30/2023Name of Facility: DOLLAR GENERAL # 15928 <br />Food Program Official Inspection Report <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 /> #35 Equipment/Utensils Approved and in Good Repair <br />OBSERVATIONS: Observed debris on doors and bottom of 2 D dairy display in back room. Clean today and maintain clean. <br />CALCODE DESCRIPTION: All utensils and equipment shall be fully operative and in good repair. (114175). All utensils and equipment <br />shall be approved, installed properly, and meet applicable standards. (114130, 114130.1, 114130.2, 114130.3, 114130.4, 114130.5, <br />114132, 114133, 114137, 114139, 114153, 114155, 114163, 114165, 114167, 114169, 114172, 114177, 114180, 114182) <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 />mop sink -- back room -- 124.00º F salad/smoothie open display -- market -- 41.00º F <br />2 D True dairy display -- back room -- 41.00º F dairy/deli display wall -- market -- 40.00º F <br />FOOD ITEM -- LOCATION -- TEMP º F -- COMMENTS <br />NOTES <br />Routine inspection. <br />Prepackaged only. <br />Discussed report with Mike Larsen, Manager. <br />No signature captured. <br />Report mailed to facility. <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 1 of 1EHD 16-23 Rev. 09/16/2020 Food Program OIR <br />FA0023094 PR0540417 SC001 01/30/2023 <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjgov.org/EHD