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SAN JOAQUIN COUNTY r' .y ENVIRONMENTAL HEALTH DEPARTMENT T 1868 East Hazelton Avenue, Stockton, CA 95205-6232 Telephone:(209)468-3420 Fax: (209)464-0138 Web:www.smqov.org/ehd FOOD PROGRAM OFFICIAL INSPECTION REPORT Name of Facility: Date: s Address: ��] City: Zip Code: Owniar/Operator: ! Telephone: Program Element: Program Record: ® Inspection Type: SB180 Posted 'Yes o Permit Posted ❑Yes No Re Inspection on or After: IN=In -site ante NIO Not Observed NIA=Not Applicable COS=Corrected on MAJ=Major Violation OUT=Not in Compliance See reverse side for code sections and general requirements that correspond to each violation listed below. 1Na"orl lations Pose a threat to public health and must be corrected immediate! . Non-compliance ma warrant closure of the food facili .. z-F .'�'"'.'�" �"z MAJ CT cos' ''_�s�-.,.w..._Y .,`J•U�ipeN,iiSlOrl,: ., i, 7rr rn . Demdnstr tion ofiKriouvledg� _. .,yi� 1. Demonstration of knowledge;food safety certificate 24. Person In Charge is present and performs duties Lr, Emp�oyeesHealth and�H.ygiiene_ _ � _ l?ersonal'Clean ines5 5i 12. Communicable disease;reporting,restrictions&exclusions 25. Personal cleanliness and hair restraints C3. No discharge from eyes,nose,or mouth;no open wounds i _ GeneraliFood•. feky:Requiretrients Proper eating,tasting,drinking,or tobacco use 26. Approved thawing methods used - - 7. Food protected from contamination during storage _ Preventing Conta ination by Hands_ Hands clean and property washed;proper glove use 28. Washing fruits and vegetables before use Handwashing facilities supplied and accessible 9. Toxic substances properly identified,stored,and used Tim a.d Temperature Relationship .Food"`Storageldisp�ylSeryice; r, 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 Proper cooling methods 32. Food property labeled and honestly presented 10. Proper cooking time and temperatures E_ pmenf?6 ensils:T;Linens;., r 11. Proper reheating procedures for hot holding 33. Nonfood contact surfaces clean x Pro e, ctton F6rri Contamina ion _ 't- 34. Warewashing facilities maintained;test strips available 12. No re-service of returned food 35. Equipmentlutensils approved;installed;clean;good repair s 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 Fr m Approved S:. c Y' _ 38. Approved and sufficient ventilation and lighting 15. Food obtained from approved source 101 J 39. Thermometers provided,accurate,and easily visible 6. Compliance with shell stock regulations;tagsldisplay 40. Proper use and storage of wiping cloths 17. Compliance with Gulf oyster regulations _ _yysleal i~aalrties_ ConforrtiancetWit Approved�Procedures : _ 41. Plumbing maintained;proper back flow prevention 18. Compliance with HACCP plan or variance conditions 42, Garbage and refuse properly disposed }� Co sumer:Advisory I; _ 3. Toilet facilities clean,supplied,and maintained 19. Advisory provided for raw or undercooked food 44. Premises;personallcleaning items;vermin-proofing ghy,5uscxSpulaf ultr _&,57 e r j�20. Prohibited foods not offered at high risk facilities 45. Floors,walls and ceiling are maintained and kept clean Waterl;Hbt Watec; 6. No living or sleeping quarters inside facility 1.Not and cold potable water available. I. _ Co p fanseandEnforcemegt�' Li-cluid Waste usposal' 7. Signs posted;last inspection report available 22- Sewage/wastewater properly disposed;toilet facility useable 8. Compliance with plan review requirements ermine ` 9- Facility operating with a valid health permit vn"J"]23, No rodents,insects,birds or animals inside facility 50. Impoundment 51. Permit Suspension Received BylTitle: EH Specialist:* Phone: !_Pi�Fa Page 1 of EHD 16-23(1st N) 419/12 F001)PROGRAM OIR