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Time In: 9.10 am <br /> Time Out: 9:45 am <br /> o .. .. San Joaquin County <br /> .X Environmental Health Department <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • �... P Telephone: (209)468-3420 Fax:(209)464-0138 Web:www.sigov.org/ehd <br /> Food Program Service Request Inspection Report <br /> Name of Facility: DUTCH BROS COFFEE Date: 04/24/2017 <br /> Address: 1665 PACIFIC AVE , STOCKTON 95204 <br /> Requestor: DUTCH BROS COFFEE, DON AZEVEDO CONSTRUCTION INC Telephone: (916)588-1020 <br /> Program Element: 1601 -FOOD PLAN CHECK Request#: SR0075593 <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: 125°F <br /> Quaternary Ammonia(QA): ppm Hand Sink Temp: 125°F <br /> FOOD ITEM--LOCATION--TEMP°F--COMMENTS <br /> 2 door true--39.00°F walk in--40.00°F <br /> NOTES <br /> All work is up to code. Return to office with a copy of this report. Program 1612 Fee$318 <br /> OK to issue permit once fee is paid <br /> Work on the following: <br /> 1.Provide food manager certificate by 60 days and food handler cards by 30 days. <br /> 2.Provide hand wash sign in rest room. <br /> 3. Install hand soap dispensers at all hand wash stations. <br /> 3comp sink, hand sink, mop sink, 10 KW water heater and rest room hand sink <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: Don Azevedo, contractor <br /> EH Specialist: MARIBEL FLOHRSCHUTZ Phone: (209)953-7817 <br /> SR0075593 SC523 04/24/2017 <br /> EHD 16-23 Rev.06/30/15 Page 1 of 1 Food Program Service Request Inspection Report <br />