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Time In: g cid am <br /> Time Out: 10.12 am <br /> avth. - San Joaquin County <br /> 'ate`°ti <br /> a Environmental Health Department <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209)468-3420 Fax:(209) 464-0138 Web:www.sjgov.oro/ehd <br /> 4��FOrra <br /> Food Program Official Inspection Report <br /> Name of Facility: TRACY USD-JACOBSON SCHOOL Date: 03/06/2015 <br /> Address: 1750W KAVANAUGH AVE,TRACY 95376 <br /> Owner/Operator: TRACY UNIFIED SCHOOL DIST Telephone: (209) 830-3200 <br /> Program Element: 1632 - EXEMPT FOOD <br /> Inspection Type: ROUTINE INSPECTION (Chargeable) <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.Noncompliance may warrant immediate closure of <br /> the food facility. <br /> #41 Plumbing Maintained;Approved Back Flow Device <br /> OBSERVATIONS: Cold water know leaks at hand wash sink. Repeat violation. Correct in 2 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 stared, and used for no other purpose. (114171, <br /> 114189 1, 114190, 114193, 114193 1, 114199, 114201, 114269) <br /> OVERALL INSPECTION COMMENTS <br /> OBSERVATIONS <br /> Name on Food Safety Certificate: Teresa Fabre Expiration Date:June 04,2018 <br /> Warewash Chlorine(Cl): ppm Heat: °F Water/Hot Water Ware Sink Temp: 120°F <br /> Quaternary Ammonia(QA): ppm Hand Sink Temp: 100°F <br /> FOOD ITEM--LOCATION--TEMP 0 F--COMMENTS <br /> Warmer-- 135.00°F True(2-door)—41.000 F <br /> True(milk)—41.00°F True(milk)--41.00°F <br /> NOTEg <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: C;6- JE� Name and Title: Michael Ennes Utility Person 2 <br /> EH Specialist: MELISSA NISSIM Phone: (209)468-3168 <br /> FA0002968 PRO162579 SC101 03/06/2015 <br /> EHD 16-23 Rev.OV30/15 Page 1 of 1 Food Program OIR <br />