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oPaUtn SAN JOAQUIN COUNT y-+ tNVIRONMENTAL HEALTH DEP/ARTMENT 1868 East Hazelton Avenue, Stockton, CA 95205-6232 Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sigov.orq/ehd �iFoa FOOD PROGRAM OFFICIAL INSPECTION REPORT Name of Facility: Date: J Address: City: Zip Code: Owner/Operator: Telephone: Program Element: Program Record: ! Inspection Type: IS 8180 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 ose a threat to Bublic health and must be corrected immediatel . Non-com Hance may warrant closure of the food facilitv N' nso .wA Demonstration of Knowledge �� ovr J s, Su ervisian' moi' P ( 1. Demonstration of knowledge; food safety certificate ies 24. Person In Charge is present and performs dut17777777- Emjiee' Health and Hygiene Personal Cleanliness �., Communicable disease; reporting, restrictions & exclusions 25. Personal cleanliness and ha;r 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 Contamtnattora by Haridr 7, m.. 27. Food protected from contamination during storage Hands clean and properly washed; proper glove use 28. Washing fruits and vegetables before use " Handwashin facilities supplied and accessible 9 PP 9. Toxic substances properly identified, stored, and used P P Y 7. Proper hot and cold holding temperatures 1 30. Food storage; food storage containers labeled 8. 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 �� M.�. .�� s-E,gUi� 11. Proper reheating procedures for hot holding 33. Nonfood contact surfaces clean `m_aaw, 1=rot1� COrn�i►�et3 34. Warewashing facilities maintained; test strips available 12. No re -service of returned food i 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 37. Vending machines maintained h7x 38. Approved and sufficient ventilation and lighting 15. Food obtained from approved source 39. Thermometersrovided, accurate, and easily visible P Y 16. Compliance with shell stock regulations; tags/display 40. Proper use and storage of wiping cloths 17. Compliance with Gulf oyster regulations .,� Conformance With Approved Procedures 41. Plumbing maintained; proper back flow prevention 18. Compliance with HACCP plan or variance conditions 2. Garbage and refuse properly disposed .Consumer Advisory 43. Toilet facilities clean, supplied, and maintained 1`,. 119. Advisory provided for raw or undercooked food 44. Premises; personal/cleaning items; vermin -proofing HighlySusceptible Populations _a Perms 45. Floors, walls and ceiling are maintained and kept clean '-, O. Prohibited foods not offered at high risk facilities Water 1 Hot Water, 46. No living or sleeping quarters inside facility . 1. Hot and cold potable water available.. -xt:,....„�x- U. Waste Disposal 47. Signs posted; last inspection report available 2. Sewage/wastewater properly disposed; toilet facility useable 48. Compliance with plan review requirements Vermin 49. Facility operating with a valid health permit 1i 1 3. No rodents, insects, birds or animals inside facility 50. Impoundment 51. Permit Suspension Received By/Title: -- - -- EH Specialist: Phone: `-; I _ ( �, i Page 1 of ? EHD 16-23 (1st pg) 4/9112 ' FOOD PROGRAM OIR