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`'.. ll � � �A�] I N Environmental Health Department <br /> `- Irl +lJ <br /> L.. v•:v COUNTY <br /> 7fa�p[r+85S grows here. Time In: 9:48 am <br /> Time Out: 10:25 am <br /> Food Program Official Inspection Report <br /> Name of Facility: SUSD-HAZELTON SCHOOL Date: 04/13/2023 <br /> Address: 535 W JEFFERSON ST, STOCKTON 95206 <br /> Owner/Operator: STOCKTON UNIFIED SCHOOL DIST Telephone: (209)933-7000 <br /> Program Element: 1632-EXEMPT FOOD <br /> Inspection Type: ROUTINE INSPECTION -Operating Permit <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 /> #41 Plumbing Maintained;Approved Back Flow Device <br /> OBSERVATIONS:The prep sink is lacking an air gap. Provide a gap distance of one inch minimum between the end of the <br /> waste pipes and the top of the floor sink. Correct within two weeks. <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 /> OVERALL INSPECTION NOTES AND COMMENTS <br /> OBSERVATIONS <br /> Name on Food Safety Certificate: Nancy Rivera Expiration Date: March 16,2024 <br /> Warewash Chlorine(Cl): ppm Heat: °F Water/Hot Water Ware Sink Temp: 133°F <br /> Quaternary Ammonia(QA): 300 ppm Hand Sink Temp: °F <br /> FOOD ITEM--LOCATION--TEMP°F--COMMENTS <br /> Prep sink--123.00°F Norlake milk box--Kitchen--41.00°F <br /> Norlake milk box--Cafeteria--41.00°F Carter Hoffman warmer--147.00°F <br /> In counter prep sink--121.00°F Beverage Air milk box--40.00°F <br /> Hand sink--Restroom--100.00°F Two door Hobart cooler--32.00°F <br /> Mop sink--120.00°F Three door Traulsen cooler--37.00°F <br /> NOTES <br /> Routine inspection. No major violations. Time given to correct minor violations. No re-inspection. <br /> Official inspection report was emailed to operator. <br /> Maintain copy of inspection report on site. <br /> To minimize person-to-person contact,the signature of the person receiving the inspection report was not captured. <br /> FA0002938 PRO160896 SCO01 04/13/2023 <br /> EHD 16-23 Rev.09/16/2020 Page 1 of 2 Food Program OR <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 />