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SAN:JOAQUIN <br />• L.0 rag: — COUNTY—"Seir <br />Grtotritis grows heti r‘.1-..:4 • <br />Environmental Health Department <br />Time In 9•10 am <br />Time Out: 9:27 am <br /> <br />Mobile Food Facility Official Inspection Report <br />Name of Facility: CHURROS NANCY #6ZJF394 Date: 03/15/2018 <br />Address: 1680 E ELEVENTH ST, STOCKTON 95206 <br />Owner/Operator: SALAZAR, JESUS Telephone: <br />Program Element: 1636 - LTD FOOD VEHICLE (PRODUCE/WHOLE FISH) <br />Inspection Type: ROUTINE INSPECTION - Operating Permit <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 foodbome 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: <br /> <br />Expiration Date: <br /> <br />Warewash Chlorine (Cl): ppm Heat: ° F Water/Hot Water Ware Sink Temp: ° F <br />Quaternary Ammonia (QA): PPm <br /> Hand Sink Temp: ° F <br />FOOD ITEM LOCATION --TEMP ° F — COMMENTS <br />No Temperature Data Collected <br />NOTES <br />License: 6ZJF394; VIN: IFBJS3IH5SHB <br />No food prep in vehicle (van). Churros stand. <br />New address is 2635 Florida Ave., Stockton, CA 95205. <br />Owners to complete a 5021 form. <br />OK to issue 2018 permit once alls fees have been paid. <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 />-Ta5iftial <br />Received by: Name and Title: Jesus Salazar, owner <br />EH Specialist: SCOTT SANGALANG Phone: (209) 468-3452 <br />FA0022953 PRO5401,14 5C001 03/15/2018 <br />EHD 16-23 Rev. 06/30/15 Page 1 of 1 Mobile Food Facility OIR <br />1868 E. Hazelton Avenue I Stockton, California 95205 I 1 209 468-3420 I F 209 464-0138 I www.sjcehd.com