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' SHADOW N Environmental Health Department <br /> r Time In: 3.10om m <br /> COUNTY <br /> ,r <br /> Time Out: 3:47 am <br /> ,._ r.,.; Greatness grc� •:s hcr . <br /> Mobile Food Facility Service Request Inspection Report <br /> Name of Facility: Date: 11/06/2019 <br /> Address: 2480 FAIRVIEW RD, HOLLISTER 95023 <br /> Requestor: ROBBIE THEDFORD, NORCAL SNOWIE Telephone: (901)849-4134 <br /> Program Element: 1603-FOOD VEHICLE INSPECTION Request#: SR0081375 <br /> Inspection Type: 061 -CONSULTATION <br /> S A' t 9 v 'F+T •,iS�r.aa,>^ s tt�i rpt s -I r <, p T xaxm 9, t: <br /> t - S : . AoccR€cTi �a °iNs � ° � A, <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 immediateN.Non-compliance may warrant immediate closure of <br /> the food facility. <br /> b11e011'11N fi 0 �4",-rOa..KAi SPEG710Nz lOTES ANI CO�IIMENTS`�� « a � `� far,G <br /> OBSERVATIONS <br /> Name on Food Safety Certificate: Expiration Date: <br /> Warewash Chlorine(Cl): ppm Heat: °F Water/Hot Water Ware Sink Temp: °F <br /> Quaternary Ammonia(QA): ppm Hand Sink Temp: 108°F <br /> FOOD ITEM—LOCATION--TEMP°F—COMMENTS <br /> No Temperature Data Collected <br /> NOTES <br /> Shaved ice vehicle(van)previously permitted in other counties. <br /> Shaved ice from purchased bagged ice and concentrates. Pre-cooked mini donuts will be reheated in toaster. <br /> License: 95252T2;VIN: 1GCWGAFG8J1175348 SAN JOAQUIN COUNTY <br /> No warewashing required. <br /> ENVIRONMENTAL <br /> FOOD <br /> Owner to complete PINK and GREEN forms. <br /> Ok to permit as PE 1633 after the above has been completed. 5023 <br /> EXPIRES 12-31-20 <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 /> W I <br /> Received by: Name and Title: Robbie Thedford, owner <br /> EH Specialist: SCOTT SANGALANG Phone: (209)468-3452 <br /> SR0081375 SCO61 11/06/2019 <br /> EHD 16-23 Rev.06/30/15 Page 1 of 1 Mobile Food Facility Service Request Inspection Report <br />