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014�f" SAN JOAQUIN COUNT' Z� ENVIRONMENTAL HEALTH DEP/ARTMENT N: X. 1868 East Hazelton Avenue, Stockton, CA 95205-6232 Telephone:(209) 468-3420 Fax:(209)464-0138 Web:www.sigov.orq/ehd C/F0•Ra FOOD PROGRAM OFFICIAL INSPECTION REPORT Name of Facility: -La" j6hiz=C Date: Address: 1 City: Zip Code: Owner/Operator: f�,/, f/// 4J('° Telephone: Program Element: Pr ram Record: Inspection Type (�Jl B180 PostedI Yes No Permit Posted Yes Igo 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. 1Na'or violations pose a threat to eublic health and must be corrected immediatel . Non-compliance may warrant closure of the food facility .. :hA I Demonstration of Knowledge ouT c'os Supervision ---- 1. Demonstration of knowledge;food safety certificate l _ t 2.4. Person In Charge is present and performs duties Employee Health and Hygiene Personal Cleanliness - i Communicable disease;reporting,restrictions&exclusions 25. Personal cleanliness and hair restraints No discharge from eyes,nose,or mouth;no open wounds General Food Safety Requirements Proper eating,tasting,drinking,or tobacco use 26. Approved thawing methods used Preventing Contaminatiori;by Hands 27. 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 Time and Temperature Relationship Food StoragefDisplay/Service 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 ; Equipment/Utensils/Linens J. Proper reheating procedures for hot holding 33. Nonfood contact surfaces clean Protection From Contamination. i 34. Warewashing facilities maintained;test strips available 12 No re-service of returned food 35. Equipment/utensils approved;installed;clean;goad repair i_ 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 Food From Approved Source 38. Approved and sufficient ventilation and lighting 39. Thermometers provided,accurate,and easily visible i�SF.od obtained from approved source e- Conformance Compliance with shell stock regulations;tags/display 40. Proper use and storage of wiping clothsCo. mpliance with Gulf oyster regulations Physical Facilities With Approved Procedures 41. Plumbing maintained;proper back flow prevention 18. Compliance with HACCP plan or variance conditions I 42. Garbage and refuse properly disposed Consumer Advisory 43. Toilet facilities clean,supplied,and maintained •o i19. Advisory provided for raw or undercooked food 44. Premises;personal/cleaning items;vermin-proofing Highly Susceptible Populations Permanent Food Facilities 0. Prohibited 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 j 1.Hot and cold potable water available. Compliance and Enforcement Liquid Waste Disposal 47. Signs posted;last inspection report available i22. Sewage,wastewater properly disposed;toilet facility useable 8. Compliance with plan review requirements Vermin 49. 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 (1st pg) 4/9/12 FOOD PROGRAM OIR