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`'.. ll � � �A�] I N Environmental Health Department <br /> `- Irl +lJ <br /> L.. v•:v COUNTY <br /> .r{ � 7fa�p[r+85S grows hire, Time In: 10.00 am <br /> Time Out: 11:00 am <br /> Food Program Official Inspection Report <br /> Name of Facility: SUSD-WILHELMINA HENRY ELEMENTARY Date: 10/13/2021 <br /> Address: 1107S WAGNER , STOCKTON 95215 <br /> Owner/Operator: STOCKTON UNIFIED SCHOOL DIST Telephone: (209)933-7045 <br /> Program Element: 1632-EXEMPT FOOD <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 foodborne illness.All major violations must be corrected immediately.Non-compliance may warrant immediate closure of <br /> the food facility. <br /> #21 Hot and Cold Potable Water Not Available <br /> OBSERVATIONS:Warm water was not available in the men's restroom hand sink. Provide warm and cold water between <br /> 100- 108 F today as they are non-adjustable faucets. <br /> CALCODE DESCRIPTION:An adequate,protected,pressurized,potable supply of hot water and cold water shall be provided at all times. <br /> (113953(c), 114099.2(b) 114101(a), 114189, 114192, 114192.1, 114195) <br /> #41 Plumbing Maintained;Approved Back Flow Device <br /> OBSERVATIONS:The food prep sink in the central kitchen area is leaking from the hot water valve. Repair replace so that <br /> this sink is in good working order. <br /> CALCODE DESCRIPTION:The potable water supply shall be protected with a backflow or back siphonage protection device,as required <br /> by applicable plumbing codes. (114192)All plumbing and plumbing fixtures shall be installed in compliance with local plumbing <br /> ordinances,shall be maintained so as to prevent any contamination,and shall be kept clean,fully operative,and in good repair. Any hose <br /> used for conveying potable water shall be of approved materials,labeled,properly stored,and used for no other purpose. (114171, <br /> 114189.1, 114190, 114193, 114193.1, 114199, 114201, 114269) <br /> OVERALL INSPECTION NOTES AND COMMENTS <br /> OBSERVATIONS <br /> Name on Food Safety Certificate: Edward Orozco Expiration Date:January 12,2026 <br /> Warewash Chlorine(Cl): ppm Heat: °F Water/Hot Water Ware Sink Temp: 130°F <br /> Quaternary Ammonia(QA): 200 ppm Hand Sink Temp: 100°F <br /> FOOD ITEM--LOCATION--TEMP°F--COMMENTS <br /> Prep sink-beside Cresor hot-hold -Kitchen--124.00°F Hand sink--Women's restroom--106.00°F <br /> Hand sink--Kitchen--108.00°F Prep sink fruit/veggie--Kitchen--120.00°F <br /> Walk-in cooler--Kitchen--41.00°F 3 comp sink--Kitchen--130.00°F <br /> Hand sink--Men's restroom--71.00°F <br /> NOTES <br /> FA0018000 PR0526593 SCO01 10/13/2021 <br /> EHD 16-23 Rev.09/16/2020 Page 1 of 2 Food Program OR <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjgov.org/EHD <br />