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SANOAQU I N Environmental Health Department <br /> COUNTY IY <br /> GrtOrAtSS grow$ here, <br /> Food Program Service Request Inspection Report <br /> Facility Name and Address: ADAM AQUA BLUE WATER, 1906 W GRANT LINE RD ,TRACY <br /> #41 Plumbing Maintained;Approved Back Flow Device <br /> OBSERVATIONS:The mop sink must have both hot(120F minimum)and cold water. Only cold this date. <br /> The front hand sink shall have hot water at 100F(minimum). 68F this date. <br /> The mop sink shall have an approved back flow prevention device(as discussed at inspection). <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: n/a Expiration Date: <br /> Warewash Chlorine(Cl): ppm Heat: °F Water/Hot Water Ware Sink Temp: 120°F <br /> Quaternary Ammonia(QA): ppm Hand Sink Temp: °F <br /> FOOD ITEM--LOCATION--TEMP°F--COMMENTS <br /> 3 comp sink--120.00°F hand sink--69.00°F <br /> restroom hand sink--100.00°F <br /> NOTES <br /> Food consultation conducted <br /> OK to permit as a 1616 once the annual permit fee is paid, photos of correction for Items#6&41 are received, and the pink <br /> and green forms are received. Submit via e-mail or text to Kadeanne Linhares (klinhares@sjgov.org/209-616-3025). <br /> No signature obtained <br /> report typed 12:53p-1:03p <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: discussed w/Nabil Asaad, owner <br /> EH Specialist: KADEANNE LINHARES Phone: (209)616-3025 <br /> SR0086601 SC061 04/21/2023 <br /> EHD 16-23 Rev.07/05/2022 Page 2 of 2 Food Program Service Request Inspection Report <br />