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�o,.gQ .coG SAN JOAQUIN COUNT H � tNVIRONMENTAL HEALTH DEPARTMENT 1868 East Hazelton Avenue, Stockton, CA 95205-6232 ;a Telephone:(209) 468-3420 Fax:(209)464-0138 Web:www.sigov.org/ehd 'QCj F O4t� FOOD PROGRAM OFFICIAL INSPECTION REPORT Name of Facility: �� v G 1 _\ ,,�S o` Date: Address: ,2 U� cJ v �� City. �r4 \ -\ Zip Code: 9 Owner/Operator: Telephone: Program Element: m y Program Record: Inspection Type: > > S6180 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. Major violations 12ose a threat to Eublic health and must be corrected immediatel . Non-corn fiance may warrant closure of the food facili ? ` � RiQt151fiat�Of1.,Of ICnOW�@G�t3@q ; 7 �alAa OUT Cos $tlAerVISA 1. Demonstration of knowledge;food safety certificate 24. Person In Charge is present and performs duties `Emplreefttt end hygiene ` = 'PerslCleanitness Communicable disease;reporting,restrictions&exclusions �� 25. Personal cleanliness and hair restraints No discharge from eyes,nose,or mouth;no open wounds ��•:_.� Ge l Fuad"Safe►, 11eM 3s Proper eating,tasting,drinking,or tobacco use a 26. Approved thawing methods used u�om to is ; '� 7. Food protected from contamination during storage x v� ., .,__�_. r. - 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 it �eCietat�ottshp � oiYe.. aa, 7. Proper hot and cold holding temperatures 30. Food storage;food storage containers labeled Proper use of time as a public health control X 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 Equlpitoe>7k128Tfs118 w. 11. Proper reheating procedures for hot holding' 33. Nonfood contact surfaces clean �x G tYim OOCtit7irietto 34. Warewashing facilities maintained;test strips available _ �ar 12. No re-service of returned foody 35. 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 E d 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 Facktjes " wCartforrrianee With:Ap avetur�s ,, 1. Plumbing maintained;proper back flow prevention �. m ,. 18. Compliance with HACCP plan or variance conditions 42. Garbage and refuse properly disposed a , JR Adv ltfefisrip, r� 3. Toilet facilities clean,supplied,and maintained 19. Advisory provided for raw or undercooked food Li 44. Premises;personal/cleaning items;vermin-proofing n,enfBGI�ItIS �c x r .,..�..�, w...... ;zYG .......... ,-.rep-» ..-.K-... -.. .�..:.,,. ._ ay�...n. erma 0. Prohibited foods not offered at high risk facilities 45. Floors,walls and ceiling are maintained and kept clean , ater' 13t3 6. No living or sleeping quarters inside facility m_ z,.�. . -... . .. 1.Hot and cold Potable water available. �;�� ti�� _ tnp>ut �ee-a a ' X ' A sMINN, r`I�� ,_a 7. Signs posted;last inspection report available sewage/wastewater properly disposed;toilet facility useable 48. Compliance with plan review requirements Ve .. ;a 49. Facility operating with a valid health permit 3. No rodents,insects,birds or animals inside facility 50. Impoundment 51. Permit Suspension Received Bylritle: -�._"-- EH Specialist: Phone: Page 1 of ' 0\ - r 1� -�.3. 121 EHD 16-23 (1st pg) 419112 FOOD PROGRAM OIR