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ot+a"tN. SAN JOAQUIN COUNT' <br /> r ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> �4ciFdti� r Telephone:(209) 468-3420 Fax., (209) 464-0138 Web:www.siaov.orD/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: ,_ Date: <br /> Address: / City: Zip Code: <br /> Owner/Operator: Telepho �. <br /> a <br /> Program Element: Program Reeord: O Inspection Type: <br /> B180 Postel No Permit Posted No Re-Inspection on or After: <br /> IN=In Compliance N/O=Not Observed N/A=Not Applicable COS=Corrected on-site MAJ=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 Pose a threat to public heath and must be Alorecontiollarice ml warrant elosm o/the food fadiltv <br /> it. Demonstration of knowledge;food safety certificate 4. Person In Charge is present and perlorms dunes <br /> Communicable disease;reporting,restrictions&exclusions S. Personal cleanliness and hair restraints <br /> No discharge from eyes,nose,or mouth;no open wounds <br /> Proper eating,tasting,drinking,or tobacco use Approved thawing methods used <br /> 7. Food protected from contamination during storage <br /> Hands clean and properly washed;proper glove use 8. Washing fruits and vegetables before use <br /> Handwashing facilities supplied and accessible Toxic substances properly identified,stored,and used <br /> Proper hot and cold holding temperatures Food storage;food storage containers labeled <br /> Proper use of time as a public health control 1. Customer self-service food protected;individual utensils provided <br /> Proper cooling methods Food properly labeled and honestly presented <br /> 10. Proper cooking time and temperatures <br /> 11. Proper reheating procedures for hot holding Nonfood contact surfaces clean <br /> . Warewashing facilities maintained;test strips available <br /> 12. No re-service of returned food 5. EquipmenVutensils approved;installed;clean;good repair <br /> 13. Food free from contamination and adulteration 6. 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 /> 15. Food obtained from approved source 39. Thermometers provided,accurate,and easily visible <br /> B. Compliance with shell stock regulations;tags/display 40. Proper use and storage of wiping cloths <br /> 17. Compliance with Gulf oyster regulations Physical Facilities <br /> • CoriT rocedures 41. Plumbing maintained;proper back flow prevention <br /> 18. Compliance with HACCP plan or variance conditions 42. Garbage and refuse properly disposed <br /> Consumer Advisory 43. Toilet facilities clean,supplied,and maintained <br /> 19. Advisory provided for raw or undercooked food 44. Premises;personal/cleaning items;vermin-proofing <br /> RwAousceptible Populations Permanent Food Fe ' ,,, `_777 � <br /> . Prohibited foods not offered at high risk facilities 45. Floors,walls and ceiling are maintained and kept clean <br /> Water/Hot Water 46- No living or sleeping quarters inside facility <br /> 1.Hot and cold potable water available. fiance and Enforcement <br /> li �pasal 7. Signs posted;last inspection report available <br /> . Sewage wastewater properly disposedtoilet facility useable 48. Compliance with plan review requirements <br /> in 49. Facility operating with a valid health permit <br /> . No rodentsinsects birds or animals inside facility 50. Impoundment <br /> 51. Permit Suspension <br /> eceived By/Title: <br /> H Specialist: Phone• ! Page 1 of117 <br /> EHD 16-23 list p9) 4)9/12 J FOOD PROGRAM OIR <br />