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SAN JOAQUIN COUNT ? tNVIRONMENTAL HEALTH DEPARTMENT N: X 1868 East Hazelton Avenue, Stockton, CA 95205-6232 Telephone: (209) 468-3420 Fax: (209) 464-0138 Web:www.sigov.org/ehd 4�iFO.R�j FOOD PROGRAM OFFICIAL INSPECTION REPORT Name of Facility: , Date: Address: / City: Zip Code: Owner/Operator: /i , -Y Telephone: Program Element: / !� ( Pro am Record: Inspection Type: SB180 Posted ,,.Yes No Permit Posted -.>s No 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.( � Ma"or violations aose a threat topublic health and must be corrected immediatel . Non-compliance may warrant closure of the food facility mr r„o'VA Demonstration of Knowledge � mit fur cos g Supervision 1. Demonstration of knowledge;food safety certificate 24. Person In Charge is present and performs duties Employee Health and Hygiene Personal Cleanliness Communicable disease;reporting,restrictions&exclusions 25. Personal cleanliness and hair restraints No discharge from eyes,nose,or mouth;no open wounds General Food Safety Ftf3ements Proper eating,lasting,drinking,or tobacco use 26. Approved thawing methods used E;- PteVentin Go13t$rdma#io3 ttds 7. Food protected from contamination during storage Hands clean and properly washed;proper glove use 28. Washing fruits and vegetables before use Hand washing facilities supplied and accessible 29. Toxic substances property identified,stored,and used Time and Temperature Relationship ". food Storagelt3 _, 7. 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 r gttl " E mss; 11. Proper reheating procedures for hot holding 33. Nonfood contact surfaces clean Protection From Contamination 34. Warewashing facilities maintained;test strips available 12. No re-service of returned food 35. Equipment/utensils approved;installed;clean;good repair 'JIM13. Food free from contamination and adulteration 36. Equipment,utensils and linens:storage and use 14. Food contact surface cleaned and sanitized/warewash i rig 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 8. Compliance with HACCP plan or variance conditions 42. Garbage and refuse properly disposed ✓� Consumer Advisory 3. 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;r ... 0. Prohibited foods not offered at high risk facilities 45. Floors,walls and ceiling are maintained and kept Olean Water/Hot Water"" 6. No living or sleeping., � ,,,: ,,: g p� g quarters inside facility 1.Hot and cold potable water available. * Liquid Waste Disposal 7. Signs posted;last inspection report available 2. Sewage/wastewater properly disposed;toilet facility useable 48. Compliance with plan review requirements Vermin 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: Mance-10 nnce-1iy EH Speciali Phon O� Page 1 of EHD 16.23 (is[p r 12 I / FOOD PROGRAM OIR