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ourH SAN JOAQUIN COUH <br /> ?i ENVIRONMENTAL HEALTH DEPARTMENT ; <br /> W. <br /> 1868 EastHazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax: (209) 464-0138 Web:www.s!aov.ora/ehd <br /> Lr�aRa <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: 1- <br /> City: Zip Code: <br /> ddress: 16UA y ry <br /> OwnerlOperator: Telephone: 4 r_'4- 21 <br /> Program Element: Program Record: Inspection Type: t�f <br /> P-111-)Posted Yes ❑ permit Posted Yes ❑ h Re-inspection on or After: <br /> 1N=In Compliance NIO=Not Observed NIA=Not Applicable COS=Corrected on-site MA.I=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 Eose a threat to eublic health and must be corrected immediafel Non-com liance ma warrant closure of the food facility <br /> ° <br /> ° <br /> 1. Demonstration of knowledge;food safety certificate 24. Person In Charge is present and performs duties <br /> Communicable disease;reporting,restrictions&exclusions 25. Personal cleanliness and hair restraints <br /> ,.° ,.° C.3t�. <br /> 3. No discharge from eyes, nose,or mouth;no open wounds <br /> Proper eating,tasting,drinking,or tobacco use 26. Approved thawing methods used <br /> e .. .. a.., - ,-::• <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 31. Customer self-service food protected;individual utensils provided <br /> Proper cooling methods 32. Food properly labeled and honestly presented <br /> 10. Proper cooking time and temperatures ' <br /> 11. Proper reheating procedures for hot holding " 33. !Nonfood contact surfaces clean <br /> 4. Warewas mg facilities maintained; e strips avar a e <br /> 12. No re-service of returned food 35. Equipmenthitensils approved;installed;clean;good repair <br /> 13. Food free from contamination and adulteration 36. Equipment,utensils and linens:storage and use <br /> 14, Food contact surface cleaned and sanitizedlwarewashing procedures 37. Vending machines maintained <br /> ,:.,.�:y;;��� ',.;-,,� -�., ,...;ttJ+i#��...°�....' ��>. -• 38. Approved and sufficient ventilation and lighting <br /> 15. Food obtained from approved source 39. Thermometers provided,accurate,and easily visible <br /> 16. Compliance with shell stock regulations;tagsidisplay 40. Proper use and storage of wiping cloths <br /> 7, <br /> Compliance with Gulf oyster regulations <br /> 1. Plumbing maintained;proper back flow prevention <br /> 18. Compliance with HACCP plan or variance conditions 42. Garbage and refuse properly disposed <br /> F-: <br /> .m. <br /> - r43, Toilet facilities clean,supplied,and maintained <br /> 19. Advisory provided for raw or undercooked food 44. Premises;personal/cleaning items;vermin-proofing <br /> ,...,"°: use0 MOWLttl €titistl 1:ett � <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 /> RaMl.Hot and cold potable water available. 8t# <br /> """ 7. Signsposted;last inspection report available <br /> ';.,.,. 2. Sewage/wastewater properly disposed;toilet facility useable 48. Compliance with plan review requirements <br /> Facility operating with a valid health permit <br /> 3. No rodents,insects,birds or animf Is inside facility 50. Impoundment <br /> 51. Permit Suspension <br /> Received By/Title: <br /> EH Specialist: Phone: Page t of <br /> FHD 16-23 (1st pg} 419112 4 FOOD PROGRAM OIR <br /> i <br />