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SAN JOAQUIN COUN' Z+ ENVIRONMENTAL HEALTH DEPARTMENT _ 1868 East Hazelton Avenue, Stockton, CA 95205-6232 • a p.. Telephone: (209) 468-3420 Fax:(209) 464-0138 Web:www.sigov.org/ehd 4�l Fij'Ft ` FOOD PROGRAM OFFICIAL INSPECTION REPORT Name of Facility: Date: Address: ,0 i S � 5�_^ �- City: \ _ Zip Code: Owner/Operator: ��x Telephone: Program Element: i 2 Program Record: Inspection Type: r� SB 180 Posted Yes No Permit Posted Yes 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 pose a threat to Eublic health and must be corrected immediate! . Non-corn /lance may warrant closure of the food facility VA of Knowledge iaa� ouF cos Supervisionoul 1. Demonstration of knowledge;food safety certificate 24. Person In Charge is present and performs duties Employee Health and Hygiene Personal Cleanliness Z. Communicable disease; reporting,restrictions&exclusions r 25. Personal cleanliness and hair restraints No discharge from eyes,nose,or mouth;no open wounds Ger l,t a ,SafetyRgq Jrements Proper eating,tasting,drinking,or tobacco use 26. Approved thawing methods used 2 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 `Time and7emperature Relationship Food StoTagetl3isplay/Service 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 9. Proper cooling methods 32. Food properly labeled and honestly presented 10. Proper cooking time and temperatures " �' Equipment'tptensils Linens 4 s ro s 1 f� 11. Proper reheating procedures for hot holding 33. Nonfood contact surfaces clean > -Pr oteC on From ContaminatioA�� '° 34. Warewashing facilities maintained;test strips available f- 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 7( 37. Vending machines maintained Food Ft . 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 regulationsPhysical Facilities Conformance With Approved Proeed'ures 41. Plumbing maintained;proper back flow prevention 18. 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 Highlysusceptible Populationsrat. '>~ _' PermaneFood Facilities RI9 0. Prohibited foods not offered at high risk facilities 5. Floors,walls and ceiling are maintained and kept clean Water/Hot Water 46. No living or sleeping quarters inside facility 1.Hot and cold potable water available. Compliance and'Enforcement Liquid Waste Disposal 47. Signs posted;last inspection report available 2. Sewage/wastewater properly disposed;toilet facility useable 48. Compliance with plan review requirements F Vermin 9. Facilityoperating with a valid health permit _4 wb21 3. No rodents,insects,birds or animals inside facility 50. Impoundment 51. Permit Suspension Received By/Title: EH Specialist: \ ^ Phone: 1 _ 3v Page 1 of C EHD 16-23 (1st pg) 4/9/12 FOOD PROGRAM OIR