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[ S1 J S =nvironmental Health Department <br /> Food Program Official Inspection Report <br /> Facility Name and Address: DOMINOS, 107 W NORTH ST, MANTECA 95336 <br /> #41 Plumbing Maintained; Approved Back Flow Device <br /> OBSERVATIONS:Pipe, draining the 3 comp sink, in the underneath floor sink, is lacking air gap. Provide air gap at least 1 <br /> inch off the floor sink. Correct in 1 week. REPEATED VIOLATION. <br /> CALCODE DESCRIPTION:The potable water supply shall be protected with a backflow or back siphonage protection device,as <br /> required by applicable plumbing codes.(114192)All plumbing and plumbing fixtures shall be installed in compliance with local <br /> plumbing ordinances,shall be maintained so as to prevent any contamination,and shall be kept clean,fully operative,and in good <br /> repair. Any hose used for conveying potable water shall be of approved materials,labeled,properly stored,and used for no other <br /> purpose.(114171, 114189.1, 114190, 114193, 114193.1, 114199, 114201, 114269) <br /> #45 Floors,Walls,Ceilings; Clean and Maintained <br /> OBSERVATIONS:Floor and hard to reach corners, underneath 2 holding units at the pizza prep line, under 3 comp sink, have <br /> food debris and build up. Clean floor today and as needed. <br /> CALCODE DESCRIPTION:The walls/ceilings shall have durable,smooth, nonabsorbent,light-colored,and washable surfaces. All <br /> floor surfaces,other than the customer service areas,shall be approved,smooth,durable and made of nonabsorbent material that is <br /> easily cleanable.Approved base coving shall be provided in all areas,except customer service areas and where food is stored in <br /> original unopened containers. Food facilities shall be fully enclosed. All food facilities shall be kept clean and in good repair. (114143 <br /> (d), 114266, 114268, 114268.1, 114271, 114272) <br /> OVERALL INSPECTION NOTES AND COMMENTS <br /> OBSERVATIONS <br /> Name on Food Safety Certificate Hayden Smulson Expiration M 04/06/2027 <br /> Warewash Chlorine(Cl): ppm Heat: °F Water/Hot Water Ware Sink Temp: 123 °F <br /> Quaternary Ammonia(QA):200 ppm Hand Sink Temp: 102 °F <br /> FOOD ITEM--LOCATION--TEMP°F--COMMENTS <br /> Hand sink--Rest room--1021 Fahrenheit Beef--Cold hold unit/Pizza prep line--410 Fahrenheit <br /> Pasta--Cold hold unit/Pizza prep line--39'Fahrenheit Tomatoes--Cold hold unit/Pizza prep line--37'Fahrenheit <br /> Sausage--Cold hold unit/Pizza prep line--37'Fahrenheit Grilled chicken--Cold hold unit/Pizza prep line--41'Fahrenheit <br /> Left 2 D reach in cooler/under prep table-- Pizza prep line--410 Right 2 D reach in cooler/under prep table--Pizza prep line-- <br /> Fahrenheit 410 Fahrenheit <br /> Mop sink--1240 Fahrenheit Shredded cheese--Cold hold unit/Pizza prep line--410 <br /> Fahrenheit <br /> NOTES <br /> PRO539463 11/21/2025 <br /> EHD 16-23 Rev.09/16/2020 Page 2 of 3 Food Program OIR <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 />