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�04" •.coG SAN JOAQUIN COUNTY .y< ENVIRONMENTAL HEALTH DEPARTMENT 1868 East Hazelton Avenue, Stockton, CA 95205-6232 Telephone: (209) 468-3420 Fax: (209) 464-0138 Web:www.siciov.org/ehd �lFOR FOOD PROGRAM OFFICIAL INSPECTION REPORT Name of Facility: Date: ddress: City: Zip Code: Owner/Operator: Telephone: Program Elemen U Frograrn Rerd: Inspection Type: SB180 Posted Yes ❑ Nb Permit Posted es [] 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. Major violations pose a threat to public health and must be corrected immediately. Non-compliance may warrant closure of the food facility Dem6nstratio of Knowledge o' Sup on 1. Demonstration of knowledge;food safety certificate 24. Person In Charge is present and performs duties E p ogee H a th and Hygsen�e y __= `_ Personal Cleanliness s- X011112. Communicable disease;reporting,restrictions&exclusions 25. Personal cleanliness and hair restraints 3. 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 P e e I C- a l 27. Food protected from contamination during storage Hands clean and properly washed;proper glove use 28. Washing fruits and vegetables before use X2016. Handwashing facilities supplied and accessible 29. Toxic substances properly identified,stored,and used ".dim and Tempe'a�ture Rela Ions ip ood Sto Di a F e 7. Proper hot and cold holding temperatures 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 U rPMM 11. Proper reheating procedures for hot holding 33. Nonfood contact surfaces clean _. otect oon From Contamination- 34. Warewashing facilities maintained;test strips available 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 ix14. Food contact surface cleaned and sanitized/warewashing procedures 37. Vending machines maintained R ed So rce 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;tagstdisplay 40. Proper use and storage of wiping cloths 17. Compliance with Gulf oyster regulations 1111"ll-Mallkcilrtie C n o ace With Appr ---ed Procedures - 1. Plumbing maintained;proper back flow prevention 18. Compliance with HACCP plan or variance conditions 2. Garbage and refuse properly disposed Consu d ory 3. 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 . SIX20. Prohibited foods not offered at high risk facilities 45. Floors,walls and ceiling are maintained and kept clean e o a 6. No living or sleeping quarters inside facility 21.Hot and cold potable water available. Compliance and En% •ement Liquid Wast D os 7. Signs posted;last inspection report available 22. Sewage/wastewater properly disposed;toilet facility useable 48. Compliance with plan review requirements Vermin pg. Facility operating with a valid health permit 23. No rodents,insects,birds or animals inside facility50. Impoundment 7151. Permit Suspension Received By/Title: EH Specialist: Phone: ' 0-3,T4- Page 1 of EHD 16-23(1st pg) 4/9/12 FOOD PROGRAM OR