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r SANJOAQUI Environmental Health Department <br /> COUNTY— Time In: 9.35 am <br /> + f }' Time Out: 10:00 am <br /> 'i�1F�s{4,k Greatness grows here, <br /> Food Program Service Request Inspection Report <br /> Name of Facility: NORTHGATE COMMUNITY PARK Date: 10/28/2021 <br /> Address: 1750 HOYT LN , MANTECA 95336 <br /> Requestor: MICHAEL ROSALES, CITY OF MANTECA Telephone: (209)456-8615 <br /> Program Element: 1601 -FOOD PLAN CHECK Request#: SR0082034 <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: Required Expiration Date: <br /> Warewash Chlorine(Cl): ppm Heat: °F Water/Hot Water Ware Sink Temp: °F <br /> Quaternary Ammonia(QA): ppm Hand Sink Temp: °F <br /> FOOD ITEM--LOCATION--TEMP°F--COMMENTS <br /> No Temperature Data Collected <br /> NOTES <br /> Final inspection. <br /> Water heater is fixed. 3 comp sink is at 150F, hand sink is at 128F and mop sink is at 165F. <br /> Right side rest room has base tiles with 3/8 inch radius extending to the walls by at least 4 inches(slim foot tiles installed). <br /> All major violations are corrected. <br /> Facility will be serving prepackaged food, hot dog, pizza (limited food preparation) <br /> Okay to operate. Obtain the permit prior operating your business. <br /> PE 1615$250 to be paid for the new health permit. <br /> Pink and green forms need to be filled out. <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: <br /> EH Specialist: GEHANE FAHMY Phone: (209)616-3052 <br /> FA0000996 SR0082034 SC523 10/28/2021 <br /> EHD 16-23 Rev.09/16/2020 Page 1 of 1 Food Program Service Request Inspection Report <br />