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SAN +JOAQUIN COUP�-�' ENVIRONMENTAL HEALTH DErARTMENT N: X 1868 East Hazelton Avenue, Stockton, CA 95205-6232 Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.sigov.org/ehd 4CiF0'�e� FOOD PROGRAM OFFICIAL INSPECTION REPORT Name of Facility: l Date: a Address: S i f16 d C < City: Zip Code: Owner/Operator: e. Telephone: (73/-7t623 Program Element: Program Record: i Inspection Type:, IS 8180 Posted es No Permit Posted Yes No Re-Inspection on or After: LLLJ 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. Maio r violations ose a threat to Eublic health and must be corrected immediatel . Non-corn liance ma warrant closure of the food facility iry so wn Demonstration of Knowledge MAJ OUT 9 cos Supervision i 1. Demonstration of knowledge;food safety certificate 24. Person In Charge is present and performs duties �' Erl1 � atd hygiene PersonalCleanliness Communicable disease;reporting,restrictions&exclusions 25. Personal cleanliness and hair restraints _._n _m L: No discharge from eyes,nose,or mouth;no open wounds General Food-Safety RequilreTents LAW Proper eating,tasting,drinking,or tobacco use 26. Approved thawing methods used Px®venting Contaminatlor by,Fjanda 7. 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 Wx 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 9. Proper cooling methods 32. Food properly labeled and honestly presented 10. Proper cooking time and temperatures Equi 11. Proper reheating procedures for hot holding 33. Nonfood contact surfaces clean 34. Ware washing facilities maintained;test strips available EMO- 12. No re-service of returned food 35. Equipmentlutensils 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 _ Dyed Source, 38. 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 Conformance With Approved PrUcedures 41. Plumbing maintained;proper back flow prevention 18. Compliance with HACCP plan or variance conditions 42. Garbage and refuse properly disposed ,:, � Surner Advisory 43. Toilet facilities clean,supplied,and maintained 771 19. Advisory provided for raw or undercooked food 1 44. Premises;personal/cleaning items;vermin-proofing �. , „- Highly Susceptible Populations bDerma ?dt�1 a 0. Prohibited foods not offered at high risk facilities 45. Floors,walls and ceiling are maintained and kept clean Water l Hot 6. No living or sleeping quarters inside facility 0 Cont Lathe an+tl Enforcement 1.Hot and cold potable water available. '. - p o. ( 7. Signs posted;last inspection report available =� 2. Sewage/wastewater properly disposed;toilet facility useable_ _ 8. Compliance with plan review requirements Yerurl t� 9. Facility operating with a valid health permit _ _ ,123. No rodents,insects,birds or animals inside facility 50. Impoundment 51. Permit Suspension Received By/Title: EH Specialist: Phone: Page1 of EHD 16-23 (1st pg) 4/T12 FOOD PROGRAM OR