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oR0.4!,y, c SAN JOAQUIN COUN-0 r, a ENVIRONMENTAL HEALTH DEPARTMENT w: < 4 1868 East Hazelton Avenue, Stockton, CA 95205-6232 • dgLiFd,RY(d'• Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.siciov.org/ehd FOOD PROGRAM OFFICIAL INSPECTION REPORT Name of Facility: _ 0 V1 X Date: Address: G Ir % h City: Zip Code: Owner/Operator: N C Telephone: 33 1 Program Element: Program Record: Inspection Type: U.VL SB180 Posted '`.Yes No Per Posted Yes No Re-Inspection on or After: IN=in Compliance N/O=Not Observed NIA=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. Ma"or violations eose a threat to public health and must be corrected immediatel . Non-compliance may warrant closure of the food facility Demonstration of Knowledge ew: our s Supervision an 11. Demonstration of knowledge,food sa`ety cenificate 24. Person In Charge is present and performs duties Employee Health and Hygiene Personal Cleanliness ^ Communicable disease,reporting,restrictions&exclusions ( 25. Persocal cleanliness and hair restraints No discharge from eyes,nose,or mouth.no open wounds General Food,Safety Requirements -w_ Proper eating,tasting,drinking,or tobacco use 26. Approved thawing methods used Preventing Contamination:by Hands 27. Food protected from contamination during storage I Hands clean and properly washed;proper glove use 28. Washing fruits and vegetables before use Handwashing facilities supplied and accessible 29. Toxic substances properly identified,stored,and used Time and Tem erature#ieiationship food Storage/Displaylser-vice Proper hot and cold holding temperatures 30. Food storage;food storage containers labeled 8. Proper use of time as a public health control 31. Customer self-service foW protected;individual utensils provided Proper cooling methods 32. Food properly labeled and honestly presented 10. Proper cooking time and temperatures :::Equipment i Utensils l Linens -y,11. Proper reheating procedures for hot holding 33. Nonfood contact surfaces clean Protection From Comaminafi` s-'.i - 34. Wamwashing facilities maintained;test strips available F.1112 No re-service of returned food 35. Equipmentfutensils approved;installed;clean;good repair H- 13. Food free from contamination and adulteration 6. Equipment,utensils and linens:storage and use 14. Food contact surface cleaned and sanitized/warewashing procedures 37. Vending machines maintained -Food From Approved Source 38. Approved and sufficient ventilation and lighting _ 15. Food 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 17. Compliance with Gulf oyster regulations Physical Facilities Conformance With Approved Procedures 41. Plumbing maintained;proper back flow prevention 18. Compliance with HACCP plan or variance conditions 42. Garbage and refuse property disposed Consumer Advisory 43. Toilet facilities clean,supplied,and maintained 19. Advisory provided for raw or undercooked food 44. Premises;personal/cleaning items;vermin-proofing Highly Susceptible Populations Permanent food Facilities 0. Prohdu too foods not offered at high risk facilities - 45, Floors,walls and ceiling are maintained and kept clean Water/Hot Water 46. No living or sleeping quarters inside facility t.Hot and cold potable water available. Compliance and Enforcement Liquid Waste Disposal 7. Signs posted:last inspection report available 22. Sewage/wastewater properly disposed;toilet faciiity uscal 48. Compliance with plan review requirements Vermin _ 9. Facility operating with a valid health permit 23- No rodents, insects,birds or anim9k inside facility 50. Impoundment _ - 51. Permit Suspension Received By/Title: EH Specialist: Phone: !Y Page t of -7 T EHO 16.23 list pg) 4/9112 FOOD PROGRAM OR