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San Joaquin County <br />Environmental Health Department <br />1868 East HazeIton Avenue, Stockton, CA95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sigov.org/ehd <br />Mobile Food Facility Service Request Inspection Report <br />Facility Name and Address: KONA ICE #15481G2, 1100 RICHARDS BLVD, SACRAMENTO <br />OBSERVATIONS <br />Name on Food Safety Certificate: <br /> <br />Expiration Date: <br /> <br />Warewash Chlorine (CD: ppm Heat: ° F Water/Hot Water Ware Sink Temp 116 ° F <br /> <br />Quaternary Ammonia (QA): <br />FOOD ITEM -- LOCATION --TEMP ° F -- COMMENTS <br />hand sink -- cart -- 101.00° F <br />3 comp -- 116.00° F <br />NOTES <br />Ok to issue permits once fees are paid <br />PE1633 (vehicle) <br />Vehicle license 15481G2 <br />VIN 1GB0GRFF6H1345328 <br />PE 1633 (cart) <br />Cart license 4PM5604 <br />license 1D9BK1410J177820 <br />Hand Sink Temp 106 ° F <br />hand sink-- vehicle-- 106.00° F <br />PPm <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: Steven Farr, Owner/Operator <br /> <br />EH Specialist: STEPHANIE RAMIREZ Phone: (209) 468-9851 <br />SR0079464 SC061 08/06/2018 <br />Page 2 of 2 Mobile Food Facility Service Request Inspection Report EHD 16-23 Rev. 06/30/15