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p <br /> SAN JOAQUIN COON <br /> ENVIRONMENTAL HEALTH DERTMENT <br /> ur <br /> 1868 East Hazelton Avenue, Stockton,CA 95205-6232 <br /> Telephone.(209) 468-3420 Fax.(209) 464-0138 Web:www.s€gov.org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility, '° A Date: <br /> / <br /> Address: O City: Zip Code. <br /> OwnerlOperator: lJ I� Telephone: ? <br /> Program Element: Mogram Record: a to,,nW Inspection Type: 1 <br /> B180 Posted Yes No Permit posted Yes No Re-inspection on or After: <br /> IN=In Compliance Nip=Not Observed NIA=Not Applicable COS=Corrected on-site IMAJ= Major Violation OUT=Not in Compliance <br /> See reverse side for code sections and general requirements that correspond to each violation listed below. <br /> Ma"or violations ose a threat to public health and must be corrected immediately. Non-tom fiance mqy warrant closure of the food facility <br /> 1. Demonstration of knowledge;food safety certificate ko 24. Person In Charge is present and performs duties <br /> ® _ d° gierjs 4ean�iiaess <br /> NVVI&. communicable disease;reporting,restrictions&exclusions 25. Personal cleanliness and hair restraints <br /> No discharge from eyes,nose,or mouth;no open wounds <br /> Proper eating,tasting,drinking,or tobacco use 26. Approved thawing methods used <br /> 7. Food protected from contamination during storage <br /> Hands clean and properly washed;proper glove use 28. Washing fruits and vegetables before use <br /> Handwashing facilities supplied and accessible 29. Toxic substances properly identified,stored,and used <br /> Proper hot and cold holding temperatures 30. Food storage;food storage containers labeled <br /> Proper use of time as a public health control i 31- Customer self-service food protected;individual utensils provided <br /> Proper cooling methods ; 2. Food properly labeled and honestly presented <br /> 10. Proper cooking time and temperatures ' <br /> 11. Proper reheating procedures for hot holding j, 33. Nonfood contact surfaces clean <br /> w . <br /> WIN <br /> 34. warewashing facilities maintained;test ships available <br /> 12. No re-service of returned food 35. Equipment/utensils approved;installed;clean;good repair <br /> 011113. Food free from contamination and adulteration 36. Equipment,utensils and linens:storage and use <br /> 14. Food contact surface cleaned and sanitized/warewashing procedures 37. Vending machines maintained <br /> 38. Approved and sufficient ventilation and lighting <br /> z <br /> t+. <br /> 15. Food obtained from approved source 39. Thermometers provided,accurate,and easily visible <br /> 6. Compliance with shell stock regulations;tags/display 40. Proper use and storage of wiping cloths <br /> �.. <br /> 7. Compliance with Guff oyster regulations cis ?!' -0_ <br /> 1. Plumbing maintained;proper back flow prevention <br /> _ 18. Compliance with HACCP plan or variance conditions 42, Garbage and refuse properly disposed <br /> _ rrf es_ 3. Toilet facilities clean,supplied,and maintained <br /> 19. Advisory provided for raw or undercooked food 44, Premises;personal/cleaning items;vermin-proofing <br /> F. <br /> WNY <br /> 0. Prohibited foods not offered at high risk facilities 45. Floors,walls and ceiling are maintained and kept clean <br /> 6. No living or sleeping quarters inside facility <br /> 1.Hot and cold potable water available. <br /> C 1, M 7W <br /> sib7. Signs posted;last inspection report available <br /> 2. Sewage/wastewater properly disposed;toilet facility useable 48. Compliance with plan review requirements <br /> -���:V�rmt[t.. � •�»� 9. Facility operating with a valid health permit <br /> if No rodents,insects,birds or animals inside foci 0. Impoundment <br /> 51. Permit Suspension <br /> Received By/Title:' <br /> Eli Specialist: Phone: - Page 1 of 'F <br /> EHD 16-23 (1st pg) 41W12 t 1`001)PROGRAM OIR <br />