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SANOAQU I N Environmental Health Department <br /> COUNTY IY <br /> GrtoWSS grow$ here, <br /> Food Program Service Request Inspection Report <br /> Facility Name and Address: EVELYN COSTA ELEMENTARY SCHOOL KITCHEN, 1675 S GOBIND BLVD , MOUNTAIN HOU <br /> #35 Equipment/Utensils Approved and in Good Repair <br /> OBSERVATIONS:The walk-in cooler has a temperature of 54F(no food in unit this date). Repair the unit to provide <br /> refrigeration at 41 F(or below)prior to the storage of potentially hazardous food. <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 /> #43 Toilet Facilites Clean/Supplied/Maintained <br /> OBSERVATIONS:The toilet paper dispenser is empty. Properly fill the toilet paper dispenser prior to operation. <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: needed Expiration Date: <br /> Warewash Chlorine(Cl): ppm Heat: 160°F Water/Hot Water Ware Sink Temp: 126°F <br /> Quaternary Ammonia(QA): ppm Hand Sink Temp: 105°F <br /> FOOD ITEM--LOCATION--TEMP°F--COMMENTS <br /> 3 comp sink--126.00°F restroom hand sink-- 103.00°F <br /> walk-in cooler--54.00°F walk-in freezer--25.00°F <br /> kitchen hand sink--120.00°F rear kitchen hand sink--110.00°F <br /> 2 comp prep sink--123.00°F 1 comp prep sink--121.00°F <br /> middle kitchen hand sink--105.00°F dish machine--160.00°F <br /> NOTES <br /> Food plan check final inspection. <br /> OK to permit as a 1632 (annual permit fee exempt facility)once pink and green MasterFile records are received. <br /> No signature obtained <br /> Report typed in the office 3:26p-3:38p <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/Todd T., Roebbelen Co <br /> EH Specialist: KADEANNE LINHARES Phone: (209)616-3025 <br /> SR0086073 SC523 07/13/2023 <br /> EHD 16-23 Rev.07/05/2022 Page 2 of 2 Food Program Service Request Inspection Report <br />