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SAN JOAQUIN COUN'1-v ENVIRONMENTAL HEALTH DEPARTMENT 1868 East Hazelton Avenue, Stockton, CA 95205-6232 Telephone: (209) 468-3420 Fax:(209) 464-0138 Web:www.sigov.org/ehd FOOD PROGRAM OFFICIAL INSPECTION REPORT Name of Facility: L Date: Address: City: Zip Code: 3 C G o PU', j rcic 99,Y,7 ,,J Owner/Operator: TV S1 Telephone: �31 66G Program Element: lk32 Program Record: S- y / Inspection Type: c 8180 Posted Wes No Permit Posted ✓Yes No Re-Inspection on or After: IN=In Compliance N/O=Not Observed N/A=Not Applicable COS=Corrected on-site MAJ=Major Violation OUT=Not in Compliance See reverse side for code sections and general requirements that correspond to each violation listed below. Major violations pose a threat to public health and must be connected Immedlete& Non-com lines may WlRant Closure of this food facility 1. Demonstration d knowledge;food safelycertificate 4. Person In Charge is present and performs duties Communicable disease;reporting,restrkmons 8 exclusions Personal cleanliness and heir restraints No discharge from eyes,now,or mouth;no open wounds Proper eating,fasting,drinking,or tobacco use 6. Approved[hawing methods used 517. Food protected from contamination during storage Hands clean and property washed,proper glove use 8. Washing fruits and vegetables before use Handwashing facilities supplied and accessible 9. Toxic substances property identified,stored,and used Proper hot and cold holding temperatures Food storage;food storage containers labeled Proper use of time as a public health control 1. Customer self-service food protected;individual utensils provided Proper cooling methods 32. Food properly labeled and honestly presented 10. Proper cooking time and temperatures 11. Proper reheating procedures for hot holding 33m Nonfood contact surfaces clean Protection From Contamination 34. Warewashing facilities maintained;test strips available 12. No re-service of returned food 35. Equipment/utensils approved;installed;clean;good repair 13. Footl free from contamination and adulteration 6. Equipment,utensils and linens:storage and use ✓ 14. Food contact sunace cleaned arid sanlllzed/w3rewashiny procedures 37. Vending machines maintained -raw " Food From ApprovedIng6urce 38. Approved and sufficient ventilation and lighting 15Food obtained from approved source 39. Thermometers provided,accurate,and easily visible - 16. Compliance with shell stock regulations;tags/display 40. Proper use and storage of wiping cloths 7. Compliance with Gulf oyster regulations Physical Facilities Conformance With Approved Procedures 41. Plumbing maintained;proper back flow prevention 18- Compliant w41, HAI-F •f,n of r n:o condi bons 42. Garbage and refuse property disposed Consumer Advisory 43. Toilet facilities clean,supplied,and maintained '19. AtiviSory provided for rev. of cndercook,d food 44. Premises:personal/cleaning items;vermin-proofing Highly Susceptible Populations Permanent Food Facilities 120. Prohibited foods not offered at high risk facilities 45- Floors,walls and ceiling are maintained and ketal elcan Water/Hot Water 46. No living or sleeping quarters inside facility 1.Hot and cold potable water available. - '8mfookement liquid Waste Disposal 47. Signs posted;last inspection report available 22. Sewagewastewater properly disposedtoilet facility useabl 48. Compliance with plan review requirements Vermin 49. Facility operating with a valid health permit 23. No rodents.'msects.birds or animals inside facility 50. Impoundment 51. Permit Suspension Received By/Title: i H Specialist: phon : " '� i Page 1 of EHD 1623 (1st pg) 09/12 FOOD PROGRAM CIR