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S A N J Q Q Q U IN Environmental Health Department <br /> ` e Q U N T Y Time In: 9:30 am <br /> Time Out: 9:50 am <br /> Greoltriess grows here. <br /> Food Program Service Request Inspection Report <br /> Name of Facility: GROUNDSTACK COFFEE Date: 08/11/2023 <br /> Address: 3210 PACIFIC AVE , STOCKTON 95204 <br /> Requestor: MARK BRION, FLOBRI LLC DBA: GROUNDSTACK COFFEE Telephone: (408)771-2664 <br /> Program Element: 1601 -FOOD PLAN CHECK Request#: SR0085925 <br /> Inspection Type: 523-Plan Check/Report Review <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 /> OVERALL INSPECTION NOTES AND COMMENTS <br /> OBSERVATIONS <br /> Name on Food Safety Certificate: 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 /> Hand sink--Restroom--100.00°F Mop sink--121.00°F <br /> NOTES <br /> Plan check final inspection.All issues resolved. No re-inspection. <br /> Ok to issue permit once pink and green sheets are received and permit fee is paid ($350). <br /> PE 1623 <br /> Discussed inspection report with Mark Brion (Owner). Emailed inspection report to operator. <br /> To minimize person-to-person contact,the signature of the person receiving the inspection report was not captured. <br /> NOTES: <br /> -In the future if vegetables,fruits and/or meats will be washed, rinsed, soaked, thawed, or similar preparation a food <br /> preparation sink will be required. <br /> -Back room with water heater will not be used for any food preparation, cooking, storage, etc. If this room is used for any of <br /> these purposes in the future then floors and cove will need to be brought up to code. <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: LYDIA BAKER Phone: (209)616-3046 <br /> SR0085925 SC523 08/11/2023 <br /> EHD 16-23 Rev.07/05/2022 Page 1 of 1 Food Program Service Request Inspection Report <br />