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SAN .JOAQUIN COU Y ENVIRONMENTAL HEALTH DENARTMENT 1868 East Hazelton Avenue, Stockton, CA 95205-6232 ;p Telephone: (209) 468-3420 Fax: (209) 464-0138 Web:www.siclov.org/ehd FOOD PROGRAM OFFICIAL INSPECTION REPORT Name of Facility: � Date: / S I Address: ^r r City: Zip Code: Owner/Operator: �. Telephone: C Program Element: Program Record: Inspection Type//, (.: �. 8180 Poste Y Yes No Permit Poste L Yes o 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 eose a threat to public health and must be corrected immediate) . Non-compliance may warrant closure of the food facili rro wn fler»onstration,of Knowledge 1W aur cos Supervision ice? 1. Demonstration of knowledge;food safety certificate 24. Person In Charge is present and performs duties Emptae"#leatiitand HygienearsoatCieahlrness 2. Communicable disease;reporting,restrictions 8 exclusions 25. Personal cleanliness and hair restraints 3. No discharge from eyes,nose,or mouth;no open wounds A;. Get>e11 foo .13egtiieinents Proper eating,tasting,drinking,or tobacco useA 6. Approved thawing methods used g. 7. Food protected from contamination during storage 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 -, .. ei�ltronsi?tp _ Proper hot and cold holding temperatures 30. Food storage;food storage containers labeled Proper use of time as a public health control 31. Customer self-service food protected;individual utensils provided Proper cooling methods 32. Food properly labeled and honestly presented 10. Proper cooking time and temperatures' Egwpmeatfltefrtsilsi a 11. Proper reheating procedures for hot holding 33. Nonfood contact surfaces clean dirt i Co1r 1 34. Warewashing facilities maintained;test strips available 12. No re-service of returned food 35. Equipment/utensils approved;installed;clean;good repair 13. Food free from contamination and adulteration 36. Equipment,utensils and linens:storage and use 14. Food contact surface cleaned and sanitized/warewashing procedures 37. Vending machines maintained r 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 a �, #�1fYsajacgi's x x �t' p4e�Nitttw�p_ �� u �� 1. Plumbing maintained;proper back flow prevention 18. Compliance with HACCP plan or variance conditions 42. Garbage and refuse properly disposed 3. Toilet facilities clean,supplied,and maintained 19. Advisory provided for raw or undercooked food 44. Premises;personal/cleaning items;vermin-proofing h#" »sb1e Poptiatis= d f x iRermaiaet o�id Facii>ti,.,t g-.y,,-S ., �. . _* .. _. ;C 0. Prohibited foods not offered at high risk facilities 45. Floors,walls and ceiling are maintained and kept clean � y 6. No living or sleeping quarters inside facility R 1.Hot and cold potable water available. Ot�fiiftiilGt< C )Eii , i 7. Signsposted;last inspection report available 2. sewage/wastewater properly disposed;toilet facility useable 48. Compliance with plan review requirements Ve Y � ;. rrmn _ � r 9. Facility operating with a valid health permit 3. No rodents,insects,birds or animals inside facility 50. Impoundment 51. Permit Suspension Received By/Title: EH Specialist: Phone: Page 1 of EHD 16-23 (1sl pg) 4/9/12 FOOD PROGRAM OIR