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} 4t4rfl. �° SAN JOAQUIN CO jr�y ENVIRONMENTAL HEALTH DEPARTMENT 600 East Main Street; Stockton, CA 95202-3029 ., Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.s ov.or /ehd FOOD PROGRAM OFFICIAL INSPECTION REPORT i Date: [Address: ame of Facility: City: Zip Code: caner/Operator: �, -/ Telephone: Program Element: Program Record: ( Inspection Type: IS B180 Posted ❑Yes D No Permit Posted ❑Yes D No Re-Inspection on or After: IN=In Compliance N/O=Not Observed NIA=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. I Ma"or violations ose a threat to public health and must be corrected immediate! . Non-com liance may warrant closure of the food facility w No WA Demonstration of Knowledge raA i our cas Supervision °"r 1. Demonstration of knowledge;food safety certificate 4. Person In Charge is present and performs duties _. __ - - Personal Cleanliness _ Employee Health and Hygiene Communicable disease;reporting,restrictions&exclusions 5. Personal cleanliness and hair restraints _ No discharge from eyes,nose,or mouth;no open wounds General Food Safety Requirements 6. Approved thawing methods used Proper eating,tasting,drinking,or tobacco use PP 9 Preventing Contamination by Hands 27. 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 and Temperature Relationship Food Storage/Display/Service Proper hot and cold holding temperatures 30. Food storage;food storage containers labeled Proper use of time as a public health control 1. Customer self-service food protected;individual utensils provided Proper cooling methods 32. Food properly labeled and honestly presented 0. Proper cooking time and temperatures Equipment!U3 ansils 1 linens 1. 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 ! 5. 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 Food From Approved Source 38. Approved and sufficient ventilation and lighting 15. Food obtained from approved source 39, Thermometers provided,accurate,and easily visible 6. Compliance with shell stock regulations;tags/display 40. Proper use and storage of wiping cloths 7. Compliance with Gulf oyster regulations Physical Facilities Conformance With Approved Procedures 41. Plumbing maintained;proper back flow prevention 18. Compliance with HACCP plan or variance conditions 42. Garbage and refuse properly disposed - �� Consumer. Advisory 43. Toilet facilities clean,supplied,and maintained 19. Advisory provided for raw or undercooked food 44. Premises;personal/cleaning items;vermin-proofing Highly Susceptible Populations _ Permanent Food Facilities 11 IV 0..Prohibited foods not offered at high risk facilities 5. Floors,walls and ceiling are maintained and kept clean -._ _...-... Water 1 Hot Water 46. No living or sleeping quarters inside facility 1.Hat and cold potable water available. Compliance and Enforcement _ . - - Liquid Waste Disposal 47. Signs posted;last inspection report available 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 1. Permit Suspension Received By/Title: r EH specialist: Phone: < Page 1 of2J. EHD 16-23 fist pg) 12/15/09 F000 PROGRAM OP A p r