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SAN JOAQUIN COUNT �: .. X ENVIRONMENTAL HEALTH DEPARTMENT 1868 East Hazelton Avenue, Stockton, CA 95205-6232 Telephone: (209) 468-3420 Fax:(209)464-0138 Web:www.sigov.org/ehd �iFpR� FOOD PROGRAM OFFICIAL INSPECTION DEPORT Name of Facility: 1, t 1� Date: Address: '1 iW. n City: G C Zip Code: C3 S3-11 Owner/Operator:J\ C h A I ne4.1 r:C; G rn t `� ;C h Telephone: S3 4 Program Element: 6 Program Record: .2 Inspection Type: 4"J.h.-c 8180 Posted ,,Yes No Permit Posted -Yes 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. "Maviolations ose a threat to ublic health and must be corrected immediate/ . Non-corn liance ma warrant closure of the food facility Demonstration of Knowledge NA, OUT c•, Supervisi. Demonstration of knowledge;food safety certificate -�� 24_ Person In Charge is present and performs duties Employee Health and Hygiene Personal Cleanliness . Communicable disease;reporting,restrictions&exclusions 25. Personal cleanlinessand hair restraints "" . No P Y discharge from eyes,nose,or mouth;no open wounds j General Food Safety Requirements Proper eating,tasting,drinking,or tobacco use 26. Approved thawing methods used _ Ct?A 7. Food protected from contamination during stora e - - ,:, ._ P 9 9 Hands clean and properly washed;proper glove use 8. Washing fruits and vegetables before use Handwashing facilities supplied and accessible 29_ Toxic substances properly identified.stored,and used Time and Temperature Relationship Food StoragelDisplay/S,e'. e 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 properly labeled and honestly presented 10. Proper cooking time and temperatures Equipment L Utensils/Linens 11. Proper reheating procedures for hot holding 33. Nonfood contact surfaces clean Prosection From ContaminationAmwov_' 34. Warewashing facilities maintained;test strips available V 12. No re-service of returned food 35. Equipment/utensils approved;installed;clean;good repair 13. Food free from contamination and adulteration 36. Equipment,utensils and linens:storage and use -r--- 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 16. Compliance with shell stock regulations;tags/display 40. Proper use and storage of wiping cloths 17. Compliance with Gulf oyster regulations Physical Fa9ities Conformance With Approved Procedures 41. Plumbing maintained;proper balk flow prevention 18. Cornpliance with HACCP plan or variance conditions 42. Garbage and refuse properly diskosed Consumer Advisory 43. Toilet facilities clean,supplied,an4 maintained 9 19. Advisory provided for raw or undercooked food 44. Premises;personal/cleaning items:vermin-proofing Highly Susceptible Populations Permanent Food Facilities, 0 Prohibited foods not offered at high risk facilities 45. Floors,walls and ceiling are maintained and kept clean Water/Hot water 46. No living or sleeping quarters inside facility 1.Hot and cold potable water available. Compliance and Enforcement Liquid Waste DispwW 47. Signs posted;last inspection report available k12. 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: _ Jl/ Phone: J/6age 1 of EHD 16-23 (1st pg) 4/9/12 FOOD PROGRAM OIR