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L ,pPa .soG SAN JOAQUIN COUK ENVIRONMENTAL HEALTH DEPARTMENT 1868 East Hazelton Avenue, Stockton, CA 95205-6232 Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.sigov.org/etld Cf FORS FOOD PROGRAM OFFICIAL INSPECTION REPORT Name of Facility: U ` ; Date: Address: _ /City: Zip Code: Cj 5 3 Owner/Operator: Telephone: Program Element: ,t�� Program Record: �j`,7 Inspection Type: B180 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. Major violations ose a threat to eublic health and must be corrected immediately. Non-com fiance maX warrant closure of the food facili mg '3Dt tiJO ?llA _. ��\�.o��a.`°a�:�. tO Of I�rIC?1Ar. d, s; `ui-r.��*�aI, L5E3T CCt5 \' -•� ...:. ,t - 1. Demonstration of knowledge;food safety certificate 24. Person In Charge is present and performs duties 9 Y \�; 1 sa `kjs.,..i w..?+ .$ fCl?Lie. ii�'R Hygtette ..`� MINIM � communicable disease;reporting,restrictions&exclusions 25. Personal cleanliness and hair restraints g a from eyes,nose,or mouth;no open wounds ' 9 Y p G uaf gm No dischare3l � e173 n Proper eating,tasting,drinking,or tobacco use 26. Approved thawing methods used „c . _ ti ... �.,, t• _ I, 7. Food protected from contamination during storage 15. 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 NX 21"MIa Proper hot and cold holding temperatures X 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 qtt SIO ,� 11 11. Proper reheating procedures for hot holding 33. Nonfood contact surfaces clean 34. Warewashing facilities maintained;fast strips available 12. No re-service of returned food 35. Equipment/utensils approved;installed;clean;good repair NW13. 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 s 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 ON 52-2 � ..�� YirtatlCe�lllith Ap _, `Lire3 -2 1. Plumbing maintained;proper back flow prevention 'N1 8. Compliance with HACCP plan or variance conditions 42. Garbage and refuse properly disposed MIN A' �� 3. Toilet facilities clean,supplied,and maintained .�. � . 06 Pp y 19. Advisoryprovided for raw or undercooked food 44. Premises;personal/cleaning items;vermin-proofing 411a 11 Ce ` S /`, -k" ! . a,j - '' f P6rma _. ,.�,_-._ n u. m - .R a 0. Prohibited foods not offered at high risk facilities 45. Floors,walls and ceiling are maintained and kept clean Yitaterc1 µ „ 6. No living or sleeping quarters inside facility M.-. __07. .. W _N. y 1.Hot and cold potable water available. �� i N � � _ K_� t: �F _ :, 7. Signs posted;last inspection report available 01 N �. .� `1 �,��' 2. Sewage/wastewater properly disposed;toilet facility useable 48. Compliance with plan review requirements 9. Facility operating with a valid health permit •3. No rodents,insects,birds or animals inside facility 50. Impoundment 1. Permit Suspension Received By(ritle: EH Specialist: Phone: �l .,� Page 1 of EHD 1&23(1st pg) 4/9/12 FOOD PROGRAM OIR