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SAN JOAQUIN COUP V ENVIRONMENTAL HEALTH DEPARTMENT 1868 East Hazelton Avenue, Stockton, CA 95205-6232 Telephone:(209) 468-3420 Fax:(209)464-0138 Web:www.sigov.org/ehd FOOD PROGRAM OFFICIAL INSPECTION REPORT Name of Facility: Date: Address: City: Zip Code: %2 X1--v ��U_ '3 Cr Owner/Operator: 4, Telephone: Program Element: Program Record: Inspection Type: IS6180 Posted Yes No Permit Posted�L 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 2ose a threat to j!ubfic health and must be corrected immediate) . Non-cornk!liance may warrant closure of the food facility IN N-* VA Demonstration of Knowledge supervision car If knowledge,food safety certificate 24. Person In Charge is present and performs duties IF Demonstration of Health and Hygiene Personal Cleanliness Communicable disease;reporting,restrictions&exclusions i 25. Personal cleanliness and hair restraints wounds No discharge from eyes,nose,or mouth;no open w General Food Safety Requirements XProper eating,tasting,drinking,or tobacco use 26. Approved thawing methods used Preventing ContaminatJi9p by Hands 27. Food protected from contamination during storage 115 Hands clean and properly washed;proper glove use 28. Washing fruits and vegetables before use ki. Handwashing facilities supplied and accessible I 29. Toxic substances properly identified,stored,and used Time and,Temperature.Relationship Food Storage/Display/Service Proper hot and cold holding temperatures 30. Food storage;food storage containers labeled N8. 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 I Utensils/Linens 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 j 35. Equipment/utensils approved;installed;clean;good repair 13. Food free from contamination and adulteration 36. Equipment,utensils and linens:storage and use 114. Food contact surface cleaned and sanitized/wa rewashing procedures 37. Vending machines maintained Food From Approved Source 38. Approved and sufficient ventilation and lighting 115. Food obtained from approved source 39. Thermometers provided,accurate,and easily visible X16. Compliance with shell stock regulations;tags/display 40. Proper use and storage of wiping cloths 1 1, 11 N1 7. Compliance with Gulf oyster regulations Physical Facilities Conformance With Approved Procedures 41. Plumbing maintained;proper back flow prevention 11 a. Compliance will[)HACCP plan or variance conditions 42. Garbage and refuse properly disposed Consumer Advisory 43. Toilet facilities clean,supplied,and maintained .............. 119. Adviso5,provided for raw or undercooked food 44. Premises;personal/cleaning items;vermin-proofing Highly Susceptible Populations Permanent Food Facilities 1 O. Prohibited foods not offered at high risk facilities 45. Floors,walls and ceiling are maintained and kept clean-Kk 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 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: "4(y L k-S Page 1 of EHD 16-23 (1sI pg) 4/9/6' FOOD PROGRAM OIR